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
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 24, 2022
Accepted:
December 19,
2022
Received:
July 5,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc. on behalf of National Lipid Association.
