Abstract 154: Trends in the Use of Lipid Lowering Therapies and LDL-C Levels in the US Adult Population with High Cardiovascular Risk Between 2003-2012

Abstract

Background: Cardiovascular disease (CVD) remains the largest cause of mortality worldwide, and will claim an estimated 20 million lives annually by 2030. For those at highest risk from CVD, lipid lowering therapies (LLT), including statins, are the mainstay of treatment. Despite the widespread use of LLTs, it remains unclear whether greater intervention is required to reduce LDL-C among those at high risk. Objectives: We examined the utilization patterns of LLTs between 2003-2012, and the proportion of LLT users with LDL<70 mg/dL among those in the 4 statin benefit groups (SBGs) defined by the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) guidelines. Methods: We used data from National Health and Nutrition Examination Survey (NHANES) between 2003-2012 to assess trends in LLTs use and percent of users with LDL-C<70 mg/dL among adults ≥18 years old in the US population who met the criteria for the 4 SBGs. We calculated frequencies, means, and percents that were weighted using NHANES-provided population weights to obtain population estimates. We conducted linear trend tests to assess whether changes in estimates were statistically significant over time. Results: The percent of adults in the 4 SBGs who used LLTs increased from 31% to 47% (p<0.001) between 2003-2012. In particular, the two SBGs with a statistically significant increase in LLTs between 2003-2012 were the group with atherosclerotic cardiovascular disease (ASCVD) (p<0.001) and the group with type 2 diabetes (p=0.046). Among LLT users overall, the percent with LDL-C<70 mg/dL increased from 11% in 2003-2004 to 22% in 2011-2012 (p<0.001). The type 2 diabetes SBG was the only one of the 4 SBGs to have a significant improvement from 2003-2012 in the percent of LLT users with LDL-C < 70 mg/dL (p=0.014). In 2011-2012, 46% of the LLT users in the type 2 diabetes SBG had an LDL-C <70 mg/dL. The other 3 SBGs experienced no significant change in the percent of LLT users with LDL-C < 70 mg/dL, even when there was an increase in the use of LLTs in that group. For instance, among people with ASCVD, 73% used LLTs in 2011-2012, yet only 20% of these users had LDL-C<70 mg/dL. Conclusions: Despite an increase in the number of people considered at high risk by the ACC/AHA guidelines and the significant rise in LLT use between 2003-2012, few LLT users have LDL-C levels less than 70 mg/dL. With recent evidence showing that lower LDL-C levels confer the greatest decreases in risk of cardiac events, a significant treatment gap and opportunity to intensify treatment remains in the US adult population at high cardiovascular risk.