Clinical implications of the American College of Cardiology/American Heart Association guidelines for the treatment of blood cholesterol for a rural community: Data from the Heart of New Ulm Project

Abstract

The 2013 American College of Cardiology (ACC)/AHA cholesterol guidelines represented a significant paradigm shift in the approach to the treatment of cholesterol in the United States. To assess prevalence of indications for statin therapy according to the ACC/AHA cholesterol guidelines in a rural community. A cross-sectional analysis was performed using data from the Heart of New Ulm Project, a population-based intervention aimed at reducing modifiable Adult Treatment Panel (ATP) III guidelines for the treatment of cholesterol for cardiovascular disease (ASCVD) risk factors in New Ulm, MN. Indications for statin therapy according to the ACC/AHA guidelines were determined using electronic health record data for area residents aged 40 to 79years with visits in 2012 to 2013. There were 7855 adults aged 40 to 79years in the target population, of which 4350 (55.4%) had a clinic visit with a fasting lipid panel. In our study sample (mean age 59.6 [10.4] years, 53.0% female), 2606 (59.9%) met one of the 4 major indications for statin therapy (19.2% clinical ASCVD, 15.5% diabetes, 1.1% low-density lipoprotein cholesterol≥190mg/dL, and 24.0%≥7.5% 10-year ASCVD risk). Of those with an indication, 63.3% were on a statin (10.9% on a high-intensity statin). Of the 1375 patients (31.6%) who were not statin eligible (10-year ASCVD risk <5%), 29.5% were on a statin. In a community sample of individuals using health care, 60% were statin eligible according to ACC/AHA guidelines and two-thirds of these patients were prescribed a statin. In addition, almost 30% of those ineligible were taking a statin, suggesting the guidelines may provide an opportunity to decrease statin use in those at low ASCVD risk.