Population prevalence of suboptimal statin use: Considering guidelines and patient preference

Many adults who qualify for lipid-lowering therapy for primary prevention of cardiovascular disease are not on treatment. This may be because they are (1) inappropriately undertreated or (2) appropriately untreated, which depends on their preferences after learning about the risks and benefits of medications used to lower atherosclerotic cardiovascular disease risk. We applied preference proportions previously derived from a diverse online sample to the 2013-2020 National Health and Nutrition Examination Survey, a nationally representative sample of the United States population, to quantify the number and proportion of adults that are likely to be appropriately treated, inappropriately undertreated, and appropriately untreated for elevated atherosclerotic cardiovascular disease risk. We found that 22.4 million additional patients would be eligible for lipid-lowering therapy by guidelines, and 7.8 million would both be eligible and likely prefer treatment. These results highlight that patient preference accounts for only a portion of the observed underuse of lipid-lowering therapy among eligible adults.