Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India

Surendra Shamkant Borgharkar,Soma Soumitra Das

doi:10.11648/j.ajhr.20200803.11

Abstract

To evaluate concordance to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline on treatment of blood cholesterol for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. Concordance to 2013 ACC/AHA guideline was assessed by retrospectively analyzing statin therapy prescribing practice as per ASCVD risk score in four statin-benefit groups in 23,295 patients aged 40-79 years from health facilities across India between 2017 and 2018. Mean (±SD) age of patients was 58.9 (±9.2) years; 62% were men; 60% (n=14,070) had clinical ASCVD. Among patients without ASCVD (n=7,122), 3.9% (n=278) had low-density lipoprotein-cholesterol (LDL-C) ≥190 mg/dL, 94.0% (n=6,694) had diabetes mellitus and 2.1% (n=150) patients had 10-year ASCVD risk ≥7.5%. Among 18,795 patients (81%) eligible for high-intensity statins, only 34% were concordant whereas 63% were treated with moderate-intensity statins. Among 2,290 patients eligible for moderate-intensity statins, 76% were concordant and 18% received high-intensity statins. Among patients with ASCVD ( 7.5%, 83% remained under-treated. Most patients (82%) with LDL-C >190 mg/dL were prescribed with moderate-intensity statins. Most patients were receiving statins at dose non-concordant to 2013 ACC/AHA guideline, reflecting gaps in real-world practice of prescribing statins for primary and secondary prevention of ASCVD. Addressing care gaps and promoting compliance to optimize statin therapy will help reduce cardiovascular disease, especially in high-risk population among South Asians.

Highlights

Atherosclerotic cardiovascular diseases (ASCVDs) are the leading cause of mortality worldwide accounting for 18 million deaths every year [1]
Age (Mean±standard deviation (SD)) 40 - 75 years > 75 years Gender Male Female Current tobacco user Body mass index* (Mean±SD) Normal (18- 22.9 kg/m2) Overweight (23 - 24.9 kg/m2) Obesity (≥25 kg/m2) Total Cholesterol (TC)† (Mean±SD) Desirable (
The prevalence of risk factors was highest among patients with ASCVD while 96.0% were receiving antihypertensive medications (Table 2)

Summary

Introduction

Atherosclerotic cardiovascular diseases (ASCVDs) are the leading cause of mortality worldwide accounting for 18 million deaths every year [1]. Middle and low-income countries contribute to 75% of the global ASCVD burden [1]. ASCVD mortality has declined in high-income countries, while low-income countries, including India, continue to bear a high burden of cardiovascular events (6.43 events/1000 person-years) and case fatality rate (17.3%) [2]. The agestandardized ASCVD death rate in India is higher than the global average [3]. ASCVDs contributed to about 28.1% of total deaths and 14.1% of disability-adjusted life years in India in 2016, which is nearly double of that observed two decades ago [4]. ASCVD trajectory is a critical challenge in India as the death rate is higher among people

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