CHICAGO — Fewer than two-thirds of patients identified as candidates for statin therapy according to 2013 ACC/AHA guidelines received the treatment over a 4-year timeframe, and even fewer patients with atherosclerotic CVD were being treated with a high-intensity statin, according to findings presented at the American Heart Association Scientific Sessions.
“The 2013 ACC/AHA cholesterol guidelines represented a paradigm shift in the approach to cholesterol treatment,” the researchers wrote. “The degree to which these guidelines have impacted statin use warrants further analysis.”
Robert Fraser, of the Minneapolis Heart Institute, and colleagues conducted a cross-sectional analysis with electronic heath records data from a large Midwestern health care system collected in 2013 and 2017. Every patient aged 40 to 79 years was included, given there was enough data on the individual to confirm the need for statin therapy based on the 2013 ACC/AHA guidelines. The researchers examined patient demographics, risk factor data, lipid values, disease states (as determined by diagnosis codes) and active orders for statins and lipid-lowering therapies to evaluate which patients were candidates for statins as well as the frequency of statin prescriptions.
The final analysis included 219,376 and 256,074 individuals in 2013 and 2017, respectively, with enough data to determine statin eligibility.
More patients in 2017 (56.1%) qualified as eligible for a statin than in 2013 (52.6%). The percentage of patients prescribed a statin in 2017 (62.1%) did not increase substantially from 2013 (61.4%); this uptick was described by the researchers as “suboptimal.”
Among patients with an atherosclerotic CVD risk of greater than 7.5%, only 39.5% were treated with a statin in 2013. That percentage did not change substantially in 2017, when only 41.7% of patients with atherosclerotic CVD risk were prescribed a statin. In addition, the prescribing of high-intensity statins among individuals with atherosclerotic CVD continued to be low, with fewer than half of eligible patients taking a high-intensity statin in 2017.
The lag of statin uptake will continue to be a concern with the release of the AHA/ACC Cholesterol Clinical Practice Guidelines, where optimized statin therapy remains the cornerstone of treatment.
“Statin allocation remains suboptimal,” the researchers wrote. “Further efforts to improve statin utilization for primary and secondary prevention are warranted.” – by Scott Buzby
Fraser R, et al. Abstract Sa1076/1076. Presented at: AHA Scientific Sessions; Chicago; Nov. 10–12, 2018.
Disclosure: The authors report no relevant financial disclosures.