Abstract 12482: Practical Adherence to AHA/ACC 2018 Guidelines Among Secondary Prevention Patients

Abstract

Introduction: Patients with ASCVD are at increased risk for CV events. The 2018 AHA/ACC lipid guidelines recommend treating these patients with high intensity or maximally tolerated statin therapy. The objective of this study was to describe lipid lowering treatment (LLT) patterns and lipid values across 7 regional health systems. Methods: We conducted a cross-sectional analysis of electronic health records transformed into the PCORnet common data model (CDM) from 7 sites in the PaTH Clinical Research Network. Adults were eligible for inclusion if an LDL-C value was measured within the past year and > 6 months of pre-index data were available prior to the first LDL-C value in the study period. We defined computable phenotypes for adults meeting AHA/ACC criteria for ASCVD at very high risk (VHR) and not at very high risk (NVHR). Medication use was assessed during the study period using the CDM prescribing table. Descriptive statistics were used to summarize LLT and lipid values within these groups and across sites. Results: NVHR patients (n=69,854) had mean (SD) LDL-C, TG and non-HDL-C of 92.1 (37), 138 (104) and 114.4 (43) mg/dl, respectively; 71% had LDL-C > 70 mg/dL, 30% had TGs 150-500 mg/dL, and 61% had non-HDL-C ≥ 100 mg/dL. VHR patients (n=117, 689) had mean (SD) LDL-C, TG and non-HDL-C of 82.9 (43), 138.5 (99), and 106 (43) mg/dl, respectively; 58.6% had LDL-C > 70 mg/dL, 30.5% had TGs 150-500 mg/dL, and 49.8% had non-HDL-C ≥ 100 mg/dL. Documented LLT in NVHR and VHR patients was 58% and 69% for statin therapy, 25% and 36% for high intensity statin therapy, 12% and 16% for statin therapy + another LLT, while 37% and 27% had no documented LLT. Conclusions: In this cross-sectional study of NVHR and VHR ASCVD patients, although most had documented statin therapy, only 25% and 36%, respectively were on high intensity statins while more than a quarter of patients had no documented LLT. Recorded LDL, TG and non-HDL-C lab values suggest there may be unaddressed risk in these populations.