Trends in high intensity statin use among secondary prevention patients 76 years and older

Abstract

Background: High intensity statin therapy (HIST) is the gold standard therapy for decreasing the risk of recurrent atherosclerotic cardiovascular disease (ASCVD); however, little is known about the use of HIST in older adults with ASCVD. Objectives: The aim of this cross-sequential study was to determine trends in statin intensity in older adults over a 10-year timeframe. Methods: The study was conducted in an integrated healthcare delivery system. Patients were 76 years or older with validated coronary ASCVD. Data were collected from administrative databases. Statin intensity level was assessed in eligible patients on January 1st and July 1st from January 1, 2007 to December 31, 2016. Results: Overall, a total of 5,453 patients were included with 2,119 (38.9%) and 3,334 (61.1%) categorized as HIST and Non-HIST, respectively. Included patients had a mean age of 79.8 years and were primarily male and white and had a cardiac intervention. The rate of HIST use increased from 14.5% to 41.3% over the study period (p<0.001 for trend). Conversely, the rates of moderate and low intensity statin use decreased from 61.8% and 9.8% to 41.2% and 4.8%, respectively (both p<0.001 for trend). Similar trends were identified for females and males. Conclusions: The percentage of patients with ASCVD 76 years and older who received HIST substantially increased from 2007 to 2016. This trend was identified in both females and males. Future comparative effectiveness research should be conducted in this patient population to examine cardiac-related outcomes with HIST and Non-HIST use.

Statin utilization and low-density lipoprotein cholesterol in statin-treated patients with atherosclerotic cardiovascular disease: Trends from a community-based health care delivery system, 2002–2016

“…3 Several studies have reported an increase in the use of HIST in the years following the release in 2013 of ACC/ AHA guidelines. [4][5][6][7][8][9][10] Nevertheless, HIST, which include atorvastatin 40-80 mg and rosuvastatin 20-40 mg daily, is still underutilized in secondary ASCVD prevention. 11,12 In theory, the uptake of HIST, as compared with lowerintensity statins, should promote greater reductions in LDL-C. Few studies, however, have reported the impact of 2013 ACC/AHA treatment guidelines or HIST utilization on LDL-C in clinical practice.…”