Abstract 18986: Low Density Lipoprotein Cholesterol Response and Statin Persistence among Patients with High Coronary Heart Disease Risk Initiating Treatment

Abstract

The 2013 American College of Cardiology/American Heart Association cholesterol treatment guideline recommends monitoring percent reduction in low density lipoprotein cholesterol (LDL-C) among patients initiating statins as an indication of response and adherence. We examined LDL-C reduction and statin persistence among high risk patients initiating statins in a real-world setting. This retrospective cohort study included 1,066 Kaiser Permanente Georgia members with a history of coronary heart disease or risk equivalent(s) initiating statins in 2011. Percent change in LDL-C was defined using measurements before and 60-450 days after statin initiation. Statin persistence was defined by proportion of days covered and categorized as high (≥80%), intermediate (50-79%), and low (<50%). Overall, 58.4% of patients failed to achieve a ≥30% LDL-C reduction after statin initiation. The prevalence of high, intermediate and low statin persistence was 41.3%, 23.2%, and 35.6%, respectively. Of patients with high persistence, 42.3% did not achieve a ≥30% reduction in LDL-C compared with 54.7%, and 79.7% of those with intermediate and low statin persistence, respectively. After multivariable adjustment and compared to high persistence, the risk ratio for a low LDL-C reduction was 1.31 (95%CI: 1.13,1.52) for intermediate persistence and 1.88 (95%CI: 1.67,2.11), for low persistence. Women and African-Americans were less likely to have high persistence while having cardiologist follow-up visits was associated with high persistence. Also, after multivariable adjustment, patients with an LDL-C ≥ 100 mg/dL versus < 100 mg/dL were less likely, while those initiating therapy with pravastatin were more likely to have a ≥30% reduction in LDL-C. In a real-world setting, many patients initiating statins did not achieve a 30% or larger LDL-C reduction. These data support the ACC/AHA recommendation to monitor LDL-C response among patients initiating statins.