Factors Associated with the Prescribing of High-Intensity Statins.

Armando Chaure-Pardos,Belén Moreno-Franco,Isabel Aguilar-Palacio,Sara Malo,Federico Arribas,María José Rabanaque

doi:10.3390/jcm9123850

Armando Chaure-Pardos, Belén Moreno-Franco + Show 4 more

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https://doi.org/10.3390/jcm9123850

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Abstract

In this study, we investigated the relationship between sociodemographic, clinical, anthropometric, and lifestyle characteristics and the type of statin prescribed for primary prevention of cardiovascular disease (CVD). We conducted an observational study in workers who began statin treatment. Statin therapy was categorized as “high-intensity” or “low–moderate-intensity”. Workers were classified according to the alignment of their statin therapy with the recommended management practices. Logistic regression models were used to evaluate the association between the different variables studied and the probability of being prescribed high-intensity statins. The only variables associated with a higher probability of being treated with high-intensity statins were increased physical activity (>40 versus <20 METs (metabolic equivalent of task) h/wk; odds ratio (OR), 1.65; 95%CI, 1.08–2.50) and, in diabetics, higher low-density lipoprotein cholesterol (LDL-C) levels (≥155 mg/dL versus <155 mg/dL; OR, 4.96; 95%CI, 1.29–19.10). The model that best predicted treatment intensity included LDL-C, diabetes, hypertension, smoking, and age (area under the Receiver Operating Characteristic curve (AUC), 0.620; 95%CI, 0.574–0.666). The prescribing and type of statin used in primary CVD prevention did not correspond with the indications in current guidelines. The probability of receiving high-intensity statins was higher in diabetics with high LDL-C levels and in more physically active individuals. These findings underscore the great variability and uncertainty in the prescribing of statins.

Highlights

Clinical practice guidelines to prevent cardiovascular disease (CVD) are based on risk assessment, recommendation of a healthy lifestyle, and, in some cases, pharmacological treatment, including lipidlowering therapy [1,2]
More than a third of the new statin users smoked at the time of prescription, 15% consumed more than 40 g of alcohol per day, and 36% had low adherence to a Mediterranean diet
The present study examines the sociodemographic, clinical, and lifestyle factors that determine the initial prescribing of high-intensity statins in clinical practice with the objective of achieving the low-density lipoprotein (LDL)-C target levels recommended in European guidelines on CVD prevention

Summary

Introduction

Clinical practice guidelines to prevent cardiovascular disease (CVD) are based on risk assessment, recommendation of a healthy lifestyle, and, in some cases, pharmacological treatment, including lipidlowering therapy [1,2]. Current European guidelines for CVD prevention consider statins as a first-line lipid-lowering option [1] These drugs have proven efficacy in the primary prevention of CVD, reducing morbidity and mortality in individuals with moderate and high risk [3]. Their effectiveness in low-risk individuals remains a topic of debate [4,5]. According to their ability to lower blood levels of low-density lipoprotein cholesterol (LDL-C), statins are typically classified as low-, moderate-, or high-intensity [6,7]. When deciding the type of statin to be prescribed, the physician must be aware of the patient’s CVD risk, as well as current and target LDL-C levels

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