Guideline recommended statin eligibility and use among U.S. adults ages 20 to 39 years

Guidelines for statin therapy emphasize treatment of adults ages 40-75 years, with less guidance for the treatment of younger adults, ages 20-39 years. Only two class 1 recommendations for statin apply to younger adults: 1) secondary prevention and 2) severe hypercholesterolemia (LDL-C ≥ 190 mg/dL). The implementation of guidelines within this age group has not been well studied.

Here, we use data from the National Health and Nutrition Examination Survey (2013-2020) to estimate statin eligibility and use among US younger adults. Based on this nationally representative sample, we extrapolate that approximately 923,000 younger adults had a history of atherosclerotic cardiovascular disease, but only ∼24 % were on statin. Among younger adults in the primary prevention group, we extrapolate that at least 1.09 million had severe hypercholesterolemia. To expand on this analysis, we calculated untreated LDL-C values for individuals on statin using two methods, and we estimate that only ∼11-20 % of younger adults with severe hypercholesterolemia were on statin. Lastly, among untreated younger adults with a class 1 indication for statin, fewer than 25 % reported that a doctor or healthcare provider had recommended cholesterol medication.

The implementation of class 1 recommendations for statin treatment in younger adults is poor. While efforts to improve risk prediction in the young have recently received significant attention, our results indicate that identifying high risk younger adults is insufficient. We must also improve guideline-recommended treatment in this age group.