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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References
- Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomized placebo-controlled trial.Lancet. 2004; 364: 685-696
- Intensive lipid lowering with atorvastatin in patients with stable coronary disease.N Engl J Med. 2005; 352: 1425-1435
- Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.N Engl J Med. 2008; 359: 2195-2207
- Cholesterol lowering in intermediate-risk persons without cardiovascular disease.N Engl J Med. 2016; 374: 2021-2031
- Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomized trials of statins: a meta-analysis.Lancet. 2008; 371: 117-125
- Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomized trials.Lancet. 2010; 376: 1670-1681
- The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomized trials.Lancet. 2012; 380: 581-590
- 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in J Am Coll Cardiol. 2014;63(25 Pt B):3024-3025] [published correction appears in J Am Coll Cardiol. 2015 Dec 22;66(24):2812].J Am Coll Cardiol. 2014; 63: 2889-2934
- 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Jun 18;139(25):e1178-e1181].Circulation. 2019; 139: e1046-e1081
- A pragmatic cluster randomized trial evaluating three implementation interventions.Implement Sci. 2012; 7: 80
- What's the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patients' notes, and interviews.BMJ. 2004; 329: 999
- Successes and failures in the implementation of evidence-based guidelines for clinical practice.Med Care. 2001; 39: II46-II54
- Clinical inertia.Ann Intern Med. 2001; 135: 825-834
- Patient-reported reasons for declining or discontinuing statin therapy: insights from the PALM registry.J Am Heart Assoc. 2019; 8: e011765
- Persistence of use of lipid-lowering medications: a cross-national study.JAMA. 1998; 279: 1458-1462
- Interpretation of the evidence for the efficacy and safety of statin therapy [published correction appears in Lancet. 2017 Feb 11;389(10069):602].Lancet. 2016; 388: 2532-2561
- Trends in prescription drug use among adults in the United States from 1999-2012.JAMA. 2015; 314: 1818-1831
- Vital signs: prevalence of key cardiovascular disease risk factors for million hearts 2022 - United States, 2011-2016.MMWR Morb Mortal Wkly Rep. 2018; 67: 983-991
- Treatment and low-density lipoprotein cholesterol management in patients diagnosed with clinical atherosclerotic cardiovascular disease in Alberta.Can J Cardiol. 2019; 35: 884-891
- Sub-optimal cholesterol response to initiation of statins and future risk of cardiovascular disease.Heart. 2019; 105: 975-981
- Cost-effectiveness of statin therapy for primary prevention in a low-cost statin era.Circulation. 2011; 124: 146-153
- Cost-effectiveness of 10-year risk thresholds for initiation of statin therapy for primary prevention of cardiovascular disease [published correction appears in JAMA. 2015 Oct 20;314(15):1647].JAMA. 2015; 314: 142-150
- Cost-effectiveness of intensifying lipid-lowering therapy with statins based on individual absolute benefit in coronary artery disease patients.J Am Heart Assoc. 2017; 6: e004648
- Evaluating the impact and cost-effectiveness of statin use guidelines for primary prevention of coronary heart disease and stroke.Circulation. 2017; 136: 1087-1098
- Ezetimibe added to statin therapy after acute coronary syndromes.N Engl J Med. 2015; 372: 2387-2397
- Alirocumab and cardiovascular outcomes after acute coronary syndrome.N Engl J Med. 2018; 379: 2097-2107
- Evolocumab and clinical outcomes in patients with cardiovascular disease.N Engl J Med. 2017; 376: 1713-1722
- Can LDL cholesterol be too low? Possible risks of extremely low levels.J Intern Med. 2017; 281: 534-553
- Efficacy and safety of further lowering of low-density lipoprotein cholesterol in patients starting with very low levels: a meta-analysis.JAMA Cardiol. 2018; 3: 823-828
- 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.Eur Heart J. 2020; 41: 111-188
- Comparison of transatlantic approaches to lipid management: The AHA/ACC/multisociety guidelines vs the ESC/EAS guidelines.Mayo Clin Proc. 2020; 95: 998-1014
- Barriers and strategies in guideline implementation-a scoping review.Healthcare (Basel). 2016; 4: 36
- 2015 ACC health policy statement on cardiovascular team-based care and the role of advanced practice providers.J Am Coll Cardiol. 2015; 65: 2118-2136
Article info
Publication history
Published online: September 15, 2020
Accepted:
September 9,
2020
Received:
July 2,
2020
Footnotes
At the time this project was conducted, Dr. Tunoa was a PGY2 Pharmacy Resident at the University of Colorado.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declarations of interest: None.
Authors' contribution: All 4 authors declare that they have materially participated in the research and article preparation. Specifically, all authors participated in the study design, interpretation of results, and creation of the manuscript. All authors have approved the final version of this manuscript.
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