Trends in prevalence of guideline-based use of lipid-lowering therapy in a large health system.
BACKGROUND
The 2013 ACC/AHA (American College of Cardiology/American Heart Association) cholesterol guidelines provided an evidence-based rationale for the allocation of lipid-lowering therapy based on risk for atherosclerotic cardiovascular disease (ASCVD). Adoption of these guidelines was initially suboptimal but whether this has improved over time remains unclear.


HYPOTHESIS
Prevalence of guideline-based statin therapy will increase over time.


METHODS
Electronic health record data were used to create two cross-sectional data sets of patients (age 40-75) served in 2013 and 2017 by a large health system. Data sets included demographics, clinical risk factors, lipid values, diagnostic codes, and active medication orders during each period. Prevalence of indications for statin therapy according to the ACC/AHA guidelines and statin prescriptions were compared between each time period.


RESULTS
In 2013, of the 219 376 adults, 57.7% of patients met statin eligibility criteria, of which 61.3% were prescribed any statin and 19.0% a high intensity statin. Among those eligible, statin use was highest in those with established ASCVD (83.9%) and lowest in those with elevated ASCVD risk >7.5% (39.3%). In 2017, of the 256 074 adults, 62.3% were statin eligible, of which 62.3% were prescribed a statin and 24.3% a high intensity statin. In 2017, 66.4% of statin eligible men were prescribed a statin compared to 57.4% of statin eligible women (P < 0.001). The use of ezetimibe (3.6% in 2013, 2.4% in 2017) and protein convertase subtilisin/kexin type 9 inhibitors (<0.1% and 0.1%) was infrequent.


CONCLUSION
In a large health system, guideline-based statin use has remained suboptimal. Improved strategies are needed to increase statin utilization in appropriate patients.
['Sidebottom|Abbey C|AC|https://orcid.org/0000-0002-5852-3539', 'Vacquier|Marc C|MC|', 'Jensen|Joseph C|JC|', 'Bradley|Steven M|SM|', 'Knickelbine|Thomas|T|', 'Strauss|Craig|C|', 'Miedema|Michael D|MD|']
D000328:Adult D000368:Aged D000572:American Heart Association D015415:Biomarkers D002309:Cardiology D002318:Cardiovascular Diseases D003430:Cross-Sectional Studies D005260:Female D005500:Follow-Up Studies D019983:Guideline Adherence D006801:Humans D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors D008055:Lipids D008297:Male D008875:Middle Aged D015995:Prevalence D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D014481:United States
cholesterol guidelines statin population health