Abstract 10434: Gaps in Ldl-C Control According to Cardiovascular Risk Status and Statin Use in Us Adults

Abstract

Background: Current US guidelines since 2013 have recommended statin use for high cardiovascular (CV) risk adults including those with atherosclerotic cardiovascular disease (ASCVD), regardless of LDL-C levels. Recent data among US population-representative adults regarding extent of LDL-C control in high CV risk persons are lacking. Methods: We examined among 4,484 US adults (representing 231 million) from the National Health and Nutrition Examination Surveys 2015-2018 the extent of statin use and remaining high LDL-C levels according to risk group as defined by the pooled cohort equation (PCE): low (<5%), intermediate (5- < 20%), high risk without ASCVD (>20% 10-year risk), diabetes without ASCVD, and high and very high risk ASCVD as defined by the 2018 cholesterol management guideline based on multiple major ASCVD events or high risk conditions. Results: Overall, 18.9% (representing 43.7 million) of US adults were on statin therapy in our cohort; this varied across risk groups from 1.4% (low risk), 10.7% (intermediate risk), 26.2% (high risk without ASCVD), 48.8% (diabetes without ASCVD), 50.8% (ASCVD high risk) and 75.4% (ASCVD very high risk), with additional ezetimibe use <5% in all groups. The figure below shows, despite statin therapy (with or without ezetimibe), >45% of high-risk primary prevention persons still have LDL-C > 100 mg/dL, >70% of those with DM to have LDL-C > 70 mg/dL, and >60% of high risk and >70% of very high-risk adults with ASCVD to have LDL-C > 70 mg/dL. Conclusions: Despite statin-focused guidelines since 2013, many US adults recommended for statin therapy are not on statins, and of those on statins, many have suboptimal LDL-C levels, warranting further LDL-C lowering with higher intensity statins and/or non-statin agents.