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Statins are rarely prescribed for incidentally discovered covert cerebrovascular disease: a retrospective cohort in a
Lester Y Leung1, Eric Puttock2, David F Kallmes3
1Tufts Medical Center, Boston, Massachusetts, USA.
Insights
Patients with incidentally discovered covert cerebrovascular diseases (id-CCD) showed a small increase in statin prescription. This finding suggests routine clinical practice does not substantially change statin use following id-CCD identification.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Incidentally discovered covert cerebrovascular diseases (id-CCD) are linked to increased stroke risk.
- Current statin prescription patterns for patients with id-CCD are not well-established.
Purpose of the Study:
- To investigate statin prescription rates in patients with id-CCD.
- To determine if id-CCD identification influences statin prescribing in real-world clinical practice.
Main Methods:
- Utilized natural language processing to identify patients aged ≥50 with id-CCD from 2009-2019.
- Employed robust Poisson multivariable regression to assess statin prescription rates before and after id-CCD diagnosis.
- Excluded patients with prior stroke, transient ischemic attack, or dementia.
Main Results:
- Over 2.4 million patients were analyzed; 31.1% had id-CCD (including covert brain infarcts and white matter disease).
- Statin prescription increased by 2.7% in id-CCD patients compared to controls within six months post-scan.
- Adjusted analyses revealed only minor increases in statin prescription associated with id-CCD presence.
Conclusions:
- Identification of id-CCD is not associated with substantial changes in statin prescription.
- Routine clinical practice demonstrates limited modification in statin prescribing habits following id-CCD diagnosis.
Introduction:
While incidentally discovered covert cerebrovascular diseases (id-CCD) are associated with future stroke, it is not known if patients with id-CCD are prescribed statins.
Methods:
Patients age ≥50 with id-CCD on neuroimaging from 2009 to 2019 with no prior ischaemic stroke, transient ischaemic attack or dementia were identified using natural language processing in a large real-world cohort. Robust Poisson multivariable regression was used to assess statin prescription among patients without prior statins.
Results:
Among 2 41 050 patients, 74 975 patients (31.1%; 4.7% with covert brain infarcts (CBI); 29.0% with white matter disease (WMD)) had id-CCD. 53.5% (95% CI 53.2 to 53.9%) were not on statins within 6 months prior to the scan. Of those, 12.0% (95% CI 11.7 to 12.3%) were prescribed statins in the next 6 months compared with 9.3% (95% CI 9.1 to 9.4%) in those without CCD, a 2.7% (95% CI 2.4 to 3.1%) absolute increase in statin prescription for those with id-CCD. In adjusted analyses, the presence of id-CCD was only associated with minor increases in statin prescription (CBI or WMD (risk ratio (RR) 1.09, 95% CI 1.05 to 1.13), CBI alone (RR 1.34, 95% CI 1.21 to 1.47), WMD alone (RR 1.05, 95% CI 1.01 to 1.09), and CBI and WMD (RR 1.23, 95% CI 1.12 to 1.35)).
Discussion:
Identification of id-CCD is not associated with substantial changes in statin prescription in routine clinical practice.
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