Open AccessTrends in prevalence of guideline‐based use of lipid‐lowering therapy in a large health system
Author(s) -
Sidebottom Abbey C.,
Vacquier Marc C.,
Jensen Joseph C.,
Bradley Steven M.,
Knickelbine Thomas,
Strauss Craig,
Miedema Michael D.
Publication year - 2020
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23347
Subject(s) - medicine , statin , ezetimibe , guideline , medical prescription , atherosclerotic cardiovascular disease , physical therapy , disease , pharmacology , pathology
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.