Trends in Use of High-Intensity Statin Therapy After Myocardial Infarction, 2011 to 2014

Rosenson, Robert S.; Farkouh, Michael E.; Mefford, Matthew T.; Bittner, Vera; Brown, Todd M.; Taylor, Ben; Monda, Keri L.; Hong, Zhao; Dai, Yuling; Muntner, Paul

doi:10.1016/j.jacc.2017.03.585

Cited by 71 publications

(44 citation statements)

References 29 publications

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“…Similarly, of 23,040 recent ACS patients with a filled statin prescription, only 27% received HIS [ 23 ]. The proportion of patients prescribed HIS in a study of 117,989 patients hospitalized for an MI was higher than that observed in our study (in 2014, the first filled prescription after discharge was HIS in 71.7% of those aged 19–64 years and 57.5% of those aged 66–75 years [ 24 ]). However, adherence to treatment post-discharge in a similar cohort of MI patients was low, with only 41.6% remaining highly adherent to HIS after 2 years [ 22 ].…”

Section: Discussioncontrasting

confidence: 84%

Statin Utilization Patterns and Outcomes for Patients with Acute Coronary Syndrome During and Following Inpatient Admissions

Boklage

Malangone-Monaco

López-González

et al. 2018

Cardiovasc Drugs Ther

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PurposeHigh-intensity statins (HIS) are recommended by current treatment guidelines for patients with clinical atherosclerotic cardiovascular disease and should be administered soon after an acute coronary syndrome (ACS) event and maintained thereafter. However, adherence to guidelines remains adequate. Statin utilization patterns during index hospitalization and the first year after ACS event, and the association between statin utilization and post-discharge clinical and economic outcomes, are described.MethodsRetrospective, observational study of US adults from the MarketScan Research Databases (2002–2014) with ≥ 1 inpatient admission for ACS and no evidence of previous ACS event < 12 months prior to index.ResultsIn total, 7802 patients met inclusion criteria. The most common index hospitalization primary diagnosis was myocardial infarction (94.6%). In the 3-month period before ACS admission, 3.4 and 14.9% of patients received HIS or low-to-moderate intensity statin, versus 13.2 and 30.7% during index hospitalization, and 16.4 and 45.1% in the year of follow-up. Of 1336 patients with a statin prescription filled on/after discharge, 53.2% filled prescriptions within 15 days of discharge and 14.9% delayed for > 91 days. The most common post-index hospital admissions for cardiovascular events were due to recurrent ACS (incidence rate = 115.2), heart failure (110.0), and revascularization (76.4). During follow-up, 2355 patients (30.2%) had all-cause inpatient admissions and 1136 (14.6%) had cardiovascular-specific admissions; mean all-cause medical and healthcare costs were $2456 and $2870, respectively, per patient per month.ConclusionsStatin dosing and utilization of HIS remains lower than recommended in current treatment guidelines, leaving patients at considerable risk of subsequent cardiovascular events.Electronic supplementary materialThe online version of this article (10.1007/s10557-018-6800-3) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 84%

Statin Utilization Patterns and Outcomes for Patients with Acute Coronary Syndrome During and Following Inpatient Admissions

Boklage

Malangone-Monaco

López-González

et al. 2018

Cardiovasc Drugs Ther

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“…Another analysis using a claims database among patients with ASCVD showed that use of high-potency statins increased from 13% in 2004 to 26% in 2012 [ 14 ]. Rosenson and colleagues assessed trends in high-intensity statin use following hospitalization for myocardial infarction using administrative claims data between 2011 and 2014 [ 15 ]. The overall use of high-intensity statins following hospital discharge increased more than two-fold over the study period to 72 and 58%, respectively, among those < 65 and 66–75 years of age.…”

Section: Discussionmentioning

confidence: 99%

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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“…This might be due to the very small number of cases (only 16) of pitavastatin use. This could be attributable to the relatively recent approval of pitavastatin (in 2009) compared to other statins and to its low prescription rate 26, 27. Thus, a more accurate onset timing for MAEs may be determined in the future if spontaneous case reports continue to accumulate in the FAERS.…”

Section: Discussionmentioning

confidence: 99%

Onset timing of statin‐induced musculoskeletal adverse events and concomitant drug‐associated shift in onset timing of MAEs

Akimoto

Negishi

Oshima

et al. 2018

Pharmacology Res & Perspec

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To evaluate the onset timing of musculoskeletal adverse events (MAEs) that develop during statin monotherapy and to determine whether concomitant drugs used concurrently with statin therapy shifts the onset timing of MAEs. Cases in which statins (atorvastatin, rosuvastatin, simvastatin, lovastatin, fluvastatin, pitavastatin, and pravastatin) were prescribed were extracted from the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) Data Files. The onset timing of MAEs during statin monotherapy was evaluated by determining the difference between statin start date and MAE onset date. The use of concomitant drugs with statin therapy was included in the analysis. Statins used in combination with concomitant drugs were compared with statin monotherapy to determine if the use of concomitant drugs shifted the onset timing of MAEs. The onset of MAEs was significantly faster with atorvastatin and rosuvastatin than with simvastatin. A difference in onset timing was not detected with other statins because the number of cases was too small for analysis. When evaluating concomitant drug use, the concomitant drugs that shifted the onset timing of MAEs could not be detected. Statins with strong low‐density lipoprotein cholesterol‐lowering effects (atorvastatin and rosuvastatin) contributed not only to a high risk of MAE onset, but also to a shorter time‐to‐onset. No concomitant drug significantly shifted the onset timing of MAEs when used concurrently with statins.

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Trends in Use of High-Intensity Statin Therapy After Myocardial Infarction, 2011 to 2014

Abstract: The use of high-intensity statins following hospitalization for MI increased progressively from 2011 through 2014.

Cited by 71 publications

References 29 publications

Statin Utilization Patterns and Outcomes for Patients with Acute Coronary Syndrome During and Following Inpatient Admissions

Statin Utilization Patterns and Outcomes for Patients with Acute Coronary Syndrome During and Following Inpatient Admissions

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

Onset timing of statin‐induced musculoskeletal adverse events and concomitant drug‐associated shift in onset timing of MAEs

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