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Recommended and observed statin use among U.S. adults – National Health and Nutrition Examination Survey, 2011-2018

  • Angela M. Thompson-Paul
    Correspondence
    Corresponding author at: Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, S107-1, Atlanta, GA 30341, United States.
    Affiliations
    U.S. Public Health Service, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  • Cathleen Gillespie
    Affiliations
    Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  • Hilary K. Wall
    Affiliations
    Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  • Fleetwood Loustalot
    Affiliations
    U.S. Public Health Service, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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  • Laurence Sperling
    Affiliations
    Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

    Emory University School of Medicine, Rollins School of Public Health, Atlanta, Georgia, USA
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  • Yuling Hong
    Correspondence
    Corresponding author at:National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
    Affiliations
    Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Published:December 24, 2022DOI:https://doi.org/10.1016/j.jacl.2022.12.005

      Highlights

      • Statin use was suboptimal (<50%) by the 2013 or 2018 cholesterol guidelines (CG).
      • Proportion of adults recommended statins was lower (2013 CG: 33.6%; 2018 CG: 19.9%).
      • An additional 21.6% of adults were considered for statin use according to 2018 CG.
      • Only 47.0% of persons aged 40-75 years with diabetes reported statin use.
      • <10% of persons with hypercholesterolemia reported statin use.

      Background

      The American College of Cardiology/American Heart Association Blood Cholesterol Guideline was published in 2013 (2013 Cholesterol Guideline) and the Multi-society Guideline on the Management of Blood Cholesterol in 2018 (2018 Cholesterol Guideline).

      Objective

      To compare differences in population level estimates for statin recommendations and use between guidelines.

      Methods

      Using four 2-year cycles from the National Health and Nutrition Examination Survey (2011-2018), we analyzed data from 8,642 non-pregnant adults aged ≥20 years with complete information for blood cholesterol measurements and other cardiovascular risk factors used to define treatment recommendations in the 2013 or 2018 Cholesterol Guidelines. We compared the prevalence of statin recommendations and use between the guidelines, overall and among patient management groups.

      Results

      Under the 2013 Cholesterol Guideline, an estimated 77.8 million (33.6%) adults would be recommended statins, compared to 46.1 million (19.9%) recommended and 50.1 million (21.6%) considered for statins by the 2018 Cholesterol Guideline. Statin use among those recommended treatment was similar utilizing the 2018 Cholesterol Guideline (47.4%) compared to the 2013 Cholesterol Guideline (47.0%). Differences were observed across demographic and patient management groups.

      Conclusion

      Compared to the 2013 Cholesterol Guideline, the prevalence of statin recommendations decreased utilizing the 2018 Cholesterol Guideline algorithm, though additional persons would be considered for treatment after risk factor assessment and patient-clinician discussion under the 2018 Cholesterol Guideline. Statin use was suboptimal (<50%) for those recommended treatment under either guideline. Optimizing patient-clinician risk discussions and shared decision making may be needed to improve treatment rates.

      Graphical abstract

      Keywords

      Abbreviations:

      ASCVD (atherosclerotic cardiovascular disease), LDL-c (low density lipoprotein cholesterol), HDL-c (high density lipoprotein cholesterol), CHD (coronary heart disease), NHANES (National Health and Nutrition Examination Survey), USPSTF (U.S. Preventive Services Task Force), NCHS (National Center for Health Statistics), NICE (National Institute for Health and Care Excellence), CCS (Canadian Cardiovascular Society), ESC/EAS (European Society of Cardiology/European Atherosclerosis Society)
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