Highlights
- •2013 American College of Cardiology/ American Heart Association cholesterol treatment guideline diverged from treat-to-target approach.
- •Greater evidence supports high-intensity statin use for at-risk populations.
- •Adoption of this guideline to practice was immediate among patients with atherosclerotic cardiovascular disease.
- •Cardiologists and endocrinologists lead in adopting guideline to medical practice.
Background
Previous research demonstrates increased utilization of high-intensity statins, but
unchanged low-density lipoprotein cholesterol (LDL-C) levels, immediately after the
2013 American College of Cardiology (ACC) and the American Heart Association (AHA)
guideline release.
Objective
The objective of this study was to determine achievement of statin therapy goals in
patients with atherosclerotic cardiovascular disease (ASCVD) before and up to 4 years
after the 2013 ACC/AHA guideline release compared with LDL-C goals of <70 mg/dL and
<100 mg/dL previously recommended by other professional societies.
Methods
The single-system cohort study used medical records, laboratory results, and claims
data (November 2012–October 2017) of adults with ≥1 claim for a statin, ≥1 ASCVD diagnosis
in propensity score-matched analyses.
Results
Among 1938 patients (mean age 70 ± 11, 48% female) with ASCVD, the percentage on high-intensity
statin therapy significantly increased over time: 24% in 2013, 34% 2014, 42% 2015,
and 49% 2016 (P < .0001). The increase in high-intensity statin use was 13 to 22% higher among patients
managed by subspecialists (cardiologist and endocrinologists) compared with those
managed by primary care providers. Mean LDL-C level was slightly, but not significantly,
lower in 2013 (80 mg/dL) than in other years: 85 mg/dL in 2014, 83 mg/dL in 2015,
and 82 mg/dL in 2016. The proportion of patients reaching LDL-C goals ranged from
51% to 56% for the <70 mg/dL target and 77% to 85% for the <100 mg/dL target over
time.
Conclusion
High-intensity statin use among secondary prevention patients increased significantly
immediately after the 2013 ACC/AHA guidelines release, primarily in those managed
by subspecialists. However, the mean LDL-C and the proportion of patients reaching
LDL-C < 70 mg/dL and < 100 mg/dL remain unchanged across comparison cohorts.
Keywords
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Article info
Publication history
Published online: March 18, 2019
Accepted:
March 7,
2019
Received:
September 6,
2018
Identification
Copyright
© 2019 National Lipid Association. All rights reserved.
