Initiation Patterns of Statins in the 2 Years After Release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Management Guideline in a Large US Health Plan

Olufade, Temitope; Zhou, Siting; Anzalone, Deborah; Kern, David M.; Tunceli, Ozgur; Cziraky, Mark J.; Willey, Vincent J.

doi:10.1161/jaha.116.005205

Cited by 21 publications

(19 citation statements)

References 19 publications

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“…In addition, adherence assessed via PDC was higher among patients in the post-guideline group (67%) vs. the historical cohort (57%). 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 ].…”

Section: Discussionsupporting

confidence: 89%

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

Harrison

Scott

Cheetham

et al. 2018

Cardiovasc Drugs Ther

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PurposeImplementation of the 2013 ACC/AHA cholesterol treatment guideline is likely to vary by statin benefit group. The aim of this study was to document trends in statin use before and after introduction of the ACC/AHA guideline.MethodsWe conducted a retrospective study with annual cohorts from 2009 to 2015 among members of Kaiser Permanente Southern California aged ≥ 21 years. Members were categorized into four mutually exclusive statin benefit groups: atherosclerotic cardiovascular disease (ASCVD), LDL-C ≥ 190 mg/dL in the last year, diabetes (aged 40–75 years), and 10-year ASCVD risk ≥ 7.5% (aged 40–75 years).ResultsThe cohorts ranged from 1,993,755 members in 2009 to 2,440,429 in 2015. Approximately 5% of patients had ASCVD, 1% had LDL-C ≥ 190 mg/dL, 6% had diabetes, and 10% had a 10-year ASCVD risk ≥ 7.5% each year. Trends in statin use were stable for adults with ASCVD (2009 78%; 2015 80%), recent LDL-C ≥ 190 mg/dL (2009 45%; 2015 44%), and diabetes (2009 74%; 2015 73%), but increased for patients with 10-year ASCVD risk ≥ 7.5% (2009 36%; 2015 47%). High-intensity statin use also increased 142% and 54% among patients with LDL-C ≥ 190 mg/dL and those with ASCVD ≤ 75 years of age, respectively. Moderate-to-high intensity statin utilization increased over 50% among those with a 10-year ASCVD risk ≥ 7.5%.ConclusionsStatin use increased substantially among patients with 10-year ASCVD risk ≥ 7.5% and use of appropriate statin dosage increased in each of the four statin benefit groups between 2009 and 2015; however, there is room for improvement.

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Section: Discussionsupporting

confidence: 89%

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

Harrison

Scott

Cheetham

et al. 2018

Cardiovasc Drugs Ther

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“…The USPSTF recommends screening for dyslipidemia every 5 years in patients age ≥40 years, but was neither for nor against screening patients age 21 to 39 years, citing lack of evidence in this age group (8). The 2013 ACC/AHA cholesterol guidelines have expanded the number of individuals eligible for statin therapy, and accordingly, recent data suggests that there has been a gradual but sustained increase in statin use for primary preventions (33). …”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk and Statin Eligibility of Young Adults After an MI

Singh

Collins

Gupta

et al. 2018

Journal of the American College of Cardiology

152

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BACKGROUND Despite significant progress in primary prevention, the rate of MI has not declined in young adults. OBJECTIVES The purpose of this study was to evaluate statin eligibility based on the 2013 American College of Cardiology/American Heart Association guidelines for treatment of blood cholesterol and 2016 U.S. Preventive Services Task Force recommendations for statin use in primary prevention in a cohort of adults who experienced a first-time myocardial infarction (MI) at a young age. METHODS The YOUNG-MI registry is a retrospective cohort from 2 large academic centers, which includes patients who experienced an MI at age ≤50 years. Diagnosis of type 1 MI was adjudicated by study physicians. Pooled cohort risk equations were used to estimate atherosclerotic cardiovascular disease risk score based on data available prior to MI or at the time of presentation. RESULTS Of 1,685 patients meeting inclusion criteria, 210 (12.5%) were on statin therapy prior to MI and were excluded. Among the remaining 1,475 individuals, the median age was 45 years, there were 294 (20%) women, and 846 (57%) had ST-segment elevation MI. At least 1 cardiovascular risk factor was present in 1,225 (83%) patients. The median 10-year atherosclerotic cardiovascular disease risk score of the cohort was 4.8% (interquartile range: 2.8% to 8.0%). Only 724 (49%) and 430 (29%) would have met criteria for statin eligibility per the 2013 American College of Cardiology/American Heart Association guidelines and 2016 U.S. Preventive Services Task Force recommendations, respectively. This finding was even more pronounced in women, in whom 184 (63%) were not eligible for statins by either guideline, compared with 549 (46%) men (p < 0.001). CONCLUSIONS The vast majority of adults who present with an MI at a young age would not have met current guideline-based treatment thresholds for statin therapy prior to their MI. These findings highlight the need for better risk assessment tools among young adults.

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“…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.…”

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confidence: 99%

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

et al. 2019

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Background: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality in the United States. The purpose of this study is to examine the rates of statin use for secondary prevention of ASCVD events in the United States over the last decade and determine whether disparities in the treatment of ASCVD still persist among women and racial/ethnic minorities. Methods: We conducted a trend analysis using data from 2008 through 2016 to describe age-adjusted trends in the use of statins for secondary prevention using the Medical Expenditure Panel Survey. We also conducted a multivariable logistic regression analysis to determine whether sociodemographic characteristics are associated with statin use during the 3 years that followed the publication of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline (2014 through 2016). Results: The prevalence of statin use among those with a history of ASCVD remained unchanged from 2008 through 2016. In 2014 to 2016, more than 40% of those aged 40 years and older with a history of ASCVD did not use statins, corresponding to approximately 9.5 million Americans. Increasing age and having been diagnosed with high cholesterol (odds ratio [OR], 6.22; P < .001) were associated with higher odds of statin use while being female (OR, 0.65; P < .001) or Hispanic (OR, 0.69; P ‫؍‬ .011) were associated with lower odds of statin use. Conclusions: Our study found there was no increase in the national rates of statin use following the ACC/AHA 2013 secondary prevention guideline and the availability of generic statins. Significant gender and ethnic disparities in ASCVD treatment remained in the United States.

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Initiation Patterns of Statins in the 2 Years After Release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Management Guideline in a Large US Health Plan

Cited by 21 publications

References 19 publications

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

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

Cardiovascular Risk and Statin Eligibility of Young Adults After an MI

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

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