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Uptake of non-statin lipid-lowering therapies for secondary prevention in community practice

Corey K Bradley1, Ahmed A Kolkailah2, Nishant P Shah3

  • 1Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA.

Journal of Clinical Lipidology
|April 7, 2023
PubMed

Insights

Many atherosclerotic cardiovascular disease patients don't reach cholesterol goals. Novel therapies like ezetimibe, PCSK9 inhibitors, and icosapent ethyl are underutilized for secondary prevention.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Atherosclerotic cardiovascular disease (ASCVD) affects millions, with many not achieving target low-density lipoprotein cholesterol (LDL-C) levels even with statin therapy.
  • Residual risk of ASCVD remains a significant concern, necessitating further lipid-lowering strategies.

Purpose of the Study:

  • To evaluate the utilization patterns of three key non-statin lipid-lowering therapies in patients with ASCVD.
  • To identify the extent of underutilization of ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), and icosapent ethyl in ASCVD secondary prevention.

Main Methods:

  • Retrospective analysis of electronic health records from 728,423 individuals with ASCVD across 89 US health systems.
  • Data collected between January 2018 and March 2021.
  • Assessment of the prescription rates for ezetimibe, PCSK9i, and icosapent ethyl.

Main Results:

  • In 2021, only 6.0% of ASCVD patients used ezetimibe, 1.6% used PCSK9i, and 1.3% used icosapent ethyl.
  • Utilization of these novel therapies showed only marginal increases throughout the study period.
  • A significant gap exists in the adoption of these effective secondary prevention agents.

Conclusions:

  • Non-statin lipid-lowering therapies are significantly underutilized in ASCVD patients.
  • Addressing this underutilization is crucial for closing the treatment gap and improving secondary prevention outcomes.
  • Increased adoption of ezetimibe, PCSK9i, and icosapent ethyl is warranted for patients with residual ASCVD risk.

Keywords:
Anticholesterolemic agentsAtherosclerosisCardiovascular diseaseLDLLipidSecondary prevention

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