Key result
High-intensity statins remain underused in ASCVD, with only ~23% of patients treated.
Why the study?
Preventive therapy among patients with established ASCVD is generally underused, and it is unknown whether new guideline recommendations have improved high-intensity statin use.
Cohort (n=601,934)
Absolute Event Rate: 22.5% vs 49.9%
There is a massive implementation gap in secondary prevention, with nearly half of insured US patients with established ASCVD not receiving any statin therapy and only 22.5% receiving guideline-recommended high-intensity statins.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This gap likely exists due to a combination of statin-associated side effects, therapeutic inertia, and the influence that social media and patient's environment has on how patient's perceive risks and benefits of statin therapy.”
“there is also irrefutable evidence that clinicians are not measuring or managing LDL-C as recommended by the American Heart Association, American College of Cardiology, multisociety guidelines.”
Persistent underuse of high-intensity statins in ASCVD may reflect implementation gaps; leaves open whether targeted interventions can reduce disparities in women and non-coronary patients.
Background: Preventive therapy among patients with established atherosclerotic cardiovascular disease (ASCVD) is generally underused. Whether new guideline recommendations and a focus on implementation have improved the use of high-intensity statins is unknown. Objectives: To evaluate the patterns and predictors of statin use among patients with ASCVD. Methods: In this retrospective cohort study, pharmacy and medical claims data from a commercial health plan were queried for patients with established ASCVD between 31st January 2018 and 31st January 2019. Statin use on an index date of 31st January 2019 was evaluated, as was 12-month adherence and discontinuation. Multivariable logistic regression was used to determine independent associations with varying intensity statin use. Results: Of the 601 934 patients with established ASCVD, 41.7% were female, mean age 67.5±13.3. Overall, 22.5% of the cohort were on a high-intensity statin, 27.6% were on low- or moderate-intensity statin, and 49.9% were not on any statin. In multivariable analysis, younger patients, females and those with higher Charlson comorbidity were less likely to be prescribed any statin. Among statin users, females, older patients and those with peripheral artery disease were less likely to be on a high-intensity formulation, while a cardiology encounter in the prior year increased the odds. The majority of high-intensity stain users achieved high levels of adherence. Conclusions: Substantial underuse of statins persists in a large, insured and contemporary cohort of patients with ASCVD from the United States. In particular, concerning gaps in appropriate statin use remain among younger patients, women and those with non-coronary ASCVD.
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Nelson et al. (2022) conducted a cohort in Atherosclerotic cardiovascular disease (ASCVD) (n=601,934). High-intensity statin vs. Low- or moderate-intensity statin, or no statin was evaluated on Statin use on an index date of 31st January 2019.
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