Evaluation of Statin Prescribing for Secondary Prevention in Primary Care Following New Guideline Recommendations

BACKGROUND: The American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Treatment of Blood Cholesterol recommends high-intensity statin therapy for most patients with established atherosclerotic cardiovascular disease (ASCVD) versus previously recommended low-density lipoprotein cholesterol targets. The impact of the ACC/AHA guidelines on prescribing patterns in primary care is uncertain. OBJECTIVE: To describe the prescribing habits of statin therapy in primary care patients with ASCVD before and after the ACC/AHA guidelines were published. METHODS: This retrospective observational study evaluated patients with ASCVD who were seen in at least 1 of 8 primary care clinics in the University of Colorado Health system. It received expedited approval by the Colorado Multiple Institutional Review Board. The primary outcome measure was the proportion of patients with established ASCVD prescribed high-intensity statin therapy within 1 year before or after guideline release. RESULTS: In total, 220 patients were included in the analysis with 110 in the before and 110 in the after cohort. For the primary outcome analysis, the rate of high-intensity statin utilization in the before versus after groups was significantly greater (25.5% vs 41.8%, P = 0.01). For ages 76 to 89 years, 36 of 37 and 29 of 30 patients in the before and after groups were receiving moderate- to high-intensity statin therapy (97.3% vs 96.7%, P = 0.99). Subgroup analysis in the after cohort for all ages showed no change in statin therapy for 77% of patients. CONCLUSIONS: High-intensity statin prescribing increased in patients with ASCVD after release of the ACC/AHA cholesterol guidelines. Our data indicate that national evidence-based guidelines may influence clinical practice in very high risk patients.