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

Abstract

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.

Statin prescription among patients with type 2 diabetes in Botswana: findings and implications

“…Whilst the proportion of patients with diabetes who are prescribed statins varies substantially worldwide; there is a low prescribing of statins both in developing and developed countries [18,19,[21][22][23][48][49][50][51]. Encouragingly, the percentage of patients with diabetes who received statins (45.5%) in our study appears appreciably higher than the 3-13% seen in some African countries and consistent with findings from developed countries where between 25 to 73% of patients with diabetes are prescribed statins [18,19,22,[48][49][50]. The proportion of statin prescription in this population is higher than has been reported in some developed countries, including Germany (25%) and the United Kingdom (33%) [18,48].…”

“…While some studies in developed countries have reported high use of statins among patients with type 2 diabetes, there has generally been under-prescribing of statins across many countries [16][17][18]. Statin prescribing among patients with type 2 diabetes is as high as 100% in developed countries but as low as 3-13% in Africa [17][18][19][20][21][22][23]. The suboptimal utilisation of statin therapy in Africa is due to many factors, but mainly limited access to standard diabetes care because of the high cost of tests and medications with typically high co-payment levels [22].…”

Trends in statin utilization among adults with severe peripheral artery disease including critical limb ischemia in an integrated healthcare delivery system

“…23 As in our study, use of high-intensity statins increased over the study period. The increase in statin use and a shift from low-to high-intensity statins in our population may be due to several factors including initiatives implemented within the healthcare system, guidelines from professional medical societies for the management of blood cholesterol and management of patients with PAD, 31 and a shift to generic statins after the patent for atorvastatin expired in 2011 potentially resulting in more widespread use of less costly generic formulations. 32 We observed that use of statins in patients with severe PAD was higher in those with concomitant cardiovascular disease (PAD and myocardial infarction: 77%; PAD and ischemic stroke: 70%).…”

Time trends analysis of statin prescription prevalence, therapy initiation, dose intensity, and utilization from the hospital information system of Jinshan Hospital, Shanghai (2012–2018)

“…A previous study has shown that the overall statins prescription rate in patients with a discharge diagnosis with ASCVD was 58.8% in West China Hospital from 2008 to 2014. It has an average 10-20% lower rate when compared with that in western or developed countries [17]. Except for a few studies [11,13,14], little is known about the detailed utilization of statins.…”