Background: Lowering low-density lipoprotein cholesterol with statins reduces risk of cardiovascular events. We examined patterns and predictors of filled prescriptions for lipid-lowering therapy (LLT) in subgroups of patients with atherosclerotic cardiovascular disease (ASCVD) and/or diabetes mellitus (DM).
Hypothesis: Statin treatment remains underutilized across subgroups of high CV risk patients.Methods: Patients in the Optum Research Database with these criteria were included: age ≥20 years, 2 years continuous enrollment, and ASCVD and/or DM. Patients were hierarchically classified by the presence of recent acute coronary syndrome, other coronary heart disease, ischemic stroke, peripheral arterial disease (PAD), or only DM. Predictors of filled LLT regimens were examined using multinomial logistic regression.Results: A total of 1 055 932 individuals met all inclusion criteria. Evidence by point-in-time analysis of filled (not only written) statin prescriptions was 45% for the overall cohort. By subgroups, this was 62%, 52%, 43%, 36%, and 40% for recent acute coronary syndrome, other coronary heart disease, ischemic stroke, PAD, and only DM, respectively. Predictors of higher rates of any statin regimen included age 50 to 69 years, male sex, absence of comorbidities, and filled prescriptions of other standard-of-care therapies.
Conclusions:In 2014, only 49% of patients with ASCVD and 40% with only DM had evidence for a filled statin prescription. Those with indications of ischemic stroke, PAD, and DM were less likely to receive statins than those with coronary conditions. Other characteristics such as advanced age, female sex, and noncardiac conditions predicted less statin utilization, thereby representing good targets for quality improvement. comprehensive analysis of the predictors and actual filled prescription patterns of statin and nonstatin lipid-lowering therapies (LLT) in subgroups of ASCVD and diabetes mellitus (DM) patients collected from a contemporary, generalizable database of US patients.
| METHODSThis was a retrospective, cross-sectional, observational study. Data were de-identified in accordance with established privacy guidelines under the Health Insurance Portability and Accountability Act; therefore, separate institutional review board approval was not sought.
| Database and cohort selectionWe utilized high-CV-risk condition(s) using 2 methods. In the first method, each patient was classified hierarchically into the highest mutually exclusive CV-risk condition (using the order above) for which he/she qualified (termed "hierarchical" subgroups). In the second method, each patient was classified into each CV-risk condition for which he/she qualified (termed "prevalent" subgroups); thus, a patient could be included in ≥1 CV condition under prevalent categorization. As an example, an individual with a history of elective coronary revascularization and DM would be hierarchically classified as "other CHD," but as both "other CHD" and "DM" by prevalent classification.
International Classific...