Brief Communication|Articles in Press

Uptake of non-statin lipid-lowering therapies for secondary prevention in community practice

Published:March 21, 2023DOI:


      • Non-statin lipid-lowering therapies reduce residual ASCVD risk.
      • Utilization of non-statin therapies is low for secondary prevention.
      • There has been limited uptake of non-statin therapies in the last several years.
      • Increasing use of these therapies is paramount to improving the treatment gap.


      Nearly two-thirds of individuals with atherosclerotic cardiovascular disease (ASCVD) do not reach target low-density lipoprotein cholesterol despite statin therapy. Three novel lipid-lowering therapies have proven to further reduce ASCVD beyond statins, including: ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), and icosapent ethyl. This study evaluated the use of these three agents in 728,423 individuals with ASCVD from 89 US health systems from 01/2018 through 03/2021 using the electronic health record. As of 2021, only 6.0% of ASCVD patients were on ezetimibe, 1.6% were on a PCSK9i, and 1.3% on icosapent ethyl, with utilization only marginally increasing over the study period. Addressing the underutilization of non-statin lipid-lowering therapy for secondary prevention is a critical step in improving the treatment gap of patients with residual risk of ASCVD.



      ASCVD (atherosclerotic cardiovascular disease), PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitors), EHR (electronic health record), LLT (lipid-lowering therapies)
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        • Wong ND
        • Zhao Y
        • Quek RGW
        • et al.
        Residual atherosclerotic cardiovascular disease risk in statin-treated adults: The Multi-Ethnic Study of Atherosclerosis.
        J. Clin. Lipidol. 2017; 11: 1223-1233
        • Cannon CP
        • de Lemos JA
        • Rosenson RS
        • et al.
        Use of lipid-lowering therapies over 2 years in GOULD, a registry of patients with atherosclerotic cardiovascular disease in the US.
        JAMA Cardiol. 2021; 6: 1060-1068
        • Bhatt DL
        • Steg PG
        • Miller M
        • et al.
        Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia.
        N. Engl. J. Med. 2018; 380: 11-22
        • Cannon CP
        • Blazing MA
        • Giugliano RP
        • et al.
        Ezetimibe added to statin therapy after acute coronary syndromes.
        N. Engl. J. Med. 2015; 372: 2387-2397
        • Sabatine MS
        • Giugliano RP
        • Keech AC
        • et al.
        Evolocumab and clinical outcomes in patients with cardiovascular disease.
        N. Engl. J. Med. 2017; 376: 1713-1722
        • Schwartz GG
        • Steg PG
        • Szarek M
        • et al.
        Alirocumab and cardiovascular outcomes after acute coronary syndrome.
        N. Engl. J. Med. 2018; 379: 2097-2107
        • Grundy SM
        • Stone NJ
        • Bailey AL
        • et al.
        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.
        J. Am. Coll. Cardiol. 2018; 73 (2019): 3168-3209
        • Ko DT
        • Khan AM
        • Kotrri G
        • et al.
        Eligibility, clinical outcomes, and budget impact of pcsk9 inhibitor adoption: the CANHEART PCSK9 study.
        J. Am. Heart Assoc. 2018; 7e010007
        • Jia X
        • Akeroyd JM
        • Nasir K
        • et al.
        Eligibility and cost for icosapent ethyl based on the REDUCE-IT Trial.
        Circulation. 2019; 139: 1341-1343
        • Dayoub EJ
        • Eberly LA
        • Nathan AS
        • et al.
        Adoption of PCSK9 inhibitors among patients with atherosclerotic disease.
        J. Am. Heart Assoc. 2021; 10e019331
        • Ray KK
        • Bays HE
        • Catapano AL
        • et al.
        Safety and efficacy of bempedoic acid to reduce LDL Cholesterol.
        N. Engl. J. Med. 2019; 380: 1022-1032
        • Ray KK
        • Wright RS
        • Kallend D
        • et al.
        Two phase 3 trials of inclisiran in patients with elevated LDL cholesterol.
        N. Engl. J. Med. 2020; 382: 1507-1519
        • Laufs U
        • Banach M
        • Mancini GBJ
        • et al.
        Efficacy and safety of bempedoic acid in patients with hypercholesterolemia and statin intolerance.
        J. Am. Heart Assoc. 2019; 8e011662