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Treatment of severe hyperlipidemia and associated cardiovascular outcomes: Data from a large healthcare system
Cameron Hallihan1, Jianhui Zhu1, Floyd Thoma1
1University of Pittsburgh Medical Center, Pittsburgh, United States (Dr Hallihan, Zhu, Thoma, Marroquin, Mulukutla, and Saeed).
Insights
High intensity statin therapy for severe hyperlipidemia (HLD) is underused, increasing atherosclerotic cardiovascular disease (ASCVD) risk. Patients not on guideline-directed statin intensity (GDSI) faced significantly higher risks of myocardial infarction and stroke.
Area of Science:
- Cardiology
- Preventive Medicine
- Pharmacology
Background:
- Severe hyperlipidemia (HLD), defined as LDL-C ≥ 190 mg/dL, necessitates primary prevention of atherosclerotic cardiovascular disease (ASCVD).
- Current guidelines recommend high-intensity statin therapy for ASCVD primary prevention in patients with severe HLD.
Purpose of the Study:
- To investigate statin utilization rates and dosages in patients with severe HLD.
- To assess the association between statin use and ASCVD outcomes in this population.
Main Methods:
- A retrospective analysis of patients with LDL-C ≥ 190 mg/dL without prior ASCVD was conducted.
- Statin use was categorized into guideline-directed statin intensity (GDSI), less than GDSI (
- Kaplan-Meier and Cox proportional hazards models analyzed time to GDSI initiation and ASCVD event risks.
Main Results:
- Only 3.7% of patients with severe HLD were on GDSI at baseline; 42% initiated GDSI within 5 years.
- Compared to GDSI, no statin use significantly increased risks of myocardial infarction (HR=2.36) and stroke/TIA (HR=2.70).
- Less than GDSI (
Conclusions:
- High-intensity statins are underutilized in patients with severe HLD.
- Underutilization of high-intensity statins is linked to an increased risk of ASCVD events.
Background:
High intensity statin therapy is currently recommended for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in patients with severe hyperlipidemia (HLD), defined as low-density lipoprotein cholesterol (LDL-C) of ≥190 mg/dL.
Objective:
We investigated rates and dosages of statin use and associated ASCVD outcomes for patients with severe HLD.
Methods:
In a large healthcare system network, patients without ASCVD with an LDL-C ≥ 190 mg/dL were identified and stratified further based on American College of Cardiology /American Heart Association 10-year risk score. Statin use was stratified as: guideline directed statin intensity (GDSI) (high intensity statin) or
Results:
Out of 282,298 primary prevention patients, a total of 5205 (1.8%) had LDL-C ≥ 190 mg/dL out of whom 3.7% were on GDSI at the index visit. Over a 5-year follow up, 42% of high-risk patients with severe HLD achieved new GDSI initiation. Compared to patients on GDSI, those on no statin therapy were at significantly higher risk of myocardial infarction (MI) (hazard ratio [HR] = 2.36, 95% CI [1.38-4.04]) and stroke/transient ischemic attack (HR = 2.70, 95% CI [1.43-5.09]). Patients on
Conclusion:
High intensity statins are underutilized among patients with severe HLD, which is linked to greater risk of ASCVD events.
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