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Early impact of the 2018 AHA/ACC/multisociety cholesterol guideline on lipid monitoring after statin initiation

  • Jennifer A. Tunoa
    Affiliations
    University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences Department of Clinical Pharmacy, Aurora, CO, USA
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  • Sarah J. Billups
    Affiliations
    University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences Department of Clinical Pharmacy, Aurora, CO, USA
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  • Rachel N. Lowe
    Affiliations
    University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences Department of Clinical Pharmacy, Aurora, CO, USA
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  • Joseph J. Saseen
    Correspondence
    Corresponding author. University of Colorado Anschutz Medical Campus, 12850 East Montview Boulevard (c238), Aurora, CO 80045, USA.
    Affiliations
    University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences Department of Clinical Pharmacy, Aurora, CO, USA

    University of Colorado Anschutz Medical Campus, Skaggs School of Medicine, Department of Family Medicine, Aurora, CO, USA
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Published:September 15, 2020DOI:https://doi.org/10.1016/j.jacl.2020.09.001

      Highlights

      • Poststatin initiation lipid monitoring increased after the 2018 guideline.
      • One in 6 patients received monitoring in accordance with guideline recommendations.
      • A total of 56% of patients with lipid monitoring warranted therapy intensification.
      • One in 20 patients had a change in therapy when clinically warranted.

      Background

      The 2018 AHA/ACC/multisociety cholesterol guideline emphasizes the need for lipid monitoring more strongly than the previous 2013 guideline to ensure patients reach recommended percent low-density lipoprotein cholesterol reductions. Real-world compliance to monitoring recommendations is currently unknown.

      Objectives

      This study examined the proportion of patients with a lipid panel measured within 3 months of statin initiation.

      Methods

      This retrospective cohort study evaluated University of Colorado Health primary care patients aged 18 to 89 years with a new statin prescription identified via the Epic Clarity database. Patients initiated on a statin during January 1, 2018 to June 30, 2018 and January 1, 2019 to June 30, 2019 were included in the pre-2018 guideline cohort and the post-2018 guideline cohort, respectively. Patients with active liver disease, pregnancy, or missing demographic data were excluded.

      Results

      A total of 13,726 patients were included, 7476 in the preguideline cohort and 6250 in the postguideline cohort. A total of 13.9% of patients in the preguideline cohort had a lipid panel completed within 3 months of statin initiation compared with 16.2% in the postguideline cohort (adjusted P < .001). In the postguideline cohort, 56% (n = 857) of patients with lipid monitoring warranted a therapeutic intensification as recommended by the 2018 guideline; however, only 5% had their lipid-lowering regimen changed.

      Conclusion

      In a large integrated health system, lipid monitoring increased among patients newly started on statin therapy soon after release of the 2018 guideline but remains low. Clinical interventions are needed to improve lipid monitoring to optimize low-density lipoprotein cholesterol–lowering therapy and ensure that guideline-recommended goals are achieved.

      Keywords

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