Effect of 2013 ACC/AHA Blood Cholesterol Guidelines on Statin Treatment Patterns and Low‐Density Lipoprotein Cholesterol in Atherosclerotic Cardiovascular Disease Patients

Abstract

BackgroundPreceding release of the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol guidelines, prescribers aimed for specific low‐density lipoprotein cholesterol (LDL‐C) goals in patients with atherosclerotic cardiovascular disease (ASCVD). The 2013 guidelines changed this focus to treating patients with appropriate statin intensity given their ASCVD risk. We examined statin use and LDL‐C levels before and after the 2013 ACC/AHA guidelines in patients with clinical ASCVD as defined in the guidelines.Methods and ResultsWe conducted a retrospective cohort study of adult commercial and Medicare Advantage health plan enrollees in the Optum Research Database. Patients had ≥1 claim with a diagnosis of clinical ASCVD between November 1, 2012 and December 31, 2014 and were continuously enrolled 6 months before (baseline) and 7 months after (follow‐up) the first ASCVD visit. Patients were assigned to monthly cohorts based on ASCVD event month. Statin use and intensity were measured at baseline and first month of follow‐up. LDL‐C changes were assessed using ordinary least squares regression. For 90 287 patients, mean (SD) age was 68 (12) years; 50% were female; and 30% had commercial insurance. Statin use remained consistent before and after guidelines (32% and 31%, respectively). Of patients receiving statins, high‐intensity use increased by 4 percentage points 1 year after guidelines (P<0.001). Mean LDL‐C levels were 2.4 mmol/L (94 mg/dL) both pre‐ and postguidelines.ConclusionsStatin use and mean monthly LDL‐C before and after the guidelines remained largely unchanged; statin intensity increased modestly. More effort may be needed to increase guideline understanding and adherence to improve treatment of high‐risk patients.

Adherence to Blood Cholesterol Treatment Guidelines Among Physicians Managing Patients With Atherosclerotic Cardiovascular Disease

“…This rate of adherence to guidelines is in-line or slightly above previously published estimates of statin use in nationally representative managed care populations. 5,9 Our chart review analysis builds on previous publications that rely on physician surveys to understand observed statin treatment patterns. 10,11 By evaluating the reasons behind therapeutic decisions documented in the notes of the prescribing physician, which is not typically available through traditional database analyses, our study provides essential information needed to better understand statin prescribing patterns.…”

Trends in Statin Use 2009–2015 in a Large Integrated Health System: Pre- and Post-2013 ACC/AHA Guideline on Treatment of Blood Cholesterol

“…Among mostly commercially insured patients covered by a national health plan, high-intensity statin use increased across the highest risk groups (ASCVD, LDL-C ≥ 190 mg/dL and diabetes with a 10-year ASCVD risk ≥ 7.5%) after guideline implementation, which is similar to the present study findings [ 6 ]. Two studies found no change or a decline in overall statin use rates in the year following the publication of the cholesterol guideline; however, there were modest increases in the proportion of ASCVD and diabetes patients on high-intensity statins following the 2013 guideline introduction [ 5 , 7 ]. Pokharel and colleagues conducted a study among patients from 161 cardiology practices participating in the Practice Innovation and Clinical Excellence (PINNACLE) Registry and found a 4% increase in moderate-to-high-intensity statin use among patients with ASCVD following adoption of the ACC/AHA guideline [ 17 ].…”

Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal

“…8 -14 Of these, we are aware of only a few studies that extend beyond the year that the guideline was published and even then only include narrowly defined populations (eg, only privately insured and/or Medicare patients, those covered by a single insurer, those within 30 days postmyocardial infarction (MI)). 10,11,13,14 We examined nationally representative data for the years 2008 through 2016 to determine whether there has been an increase in use of statins in persons with a history of ASCVD following the publication of the ACC/AHA guideline in 2013. Prior studies have tended to focus on narrower samples whereas ours contains a nationally representative sample of adults with any history of ASCVD, the wider population targeted by the ACC/AHA guideline.…”