Guidelines impact cholesterol management

Abstract

Previous research demonstrates increased utilization of high-intensity statins, but unchanged low-density lipoprotein cholesterol (LDL-C) levels, immediately after the 2013 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline release. The objective of this study was to determine achievement of statin therapy goals in patients with atherosclerotic cardiovascular disease (ASCVD) before and up to 4years after the 2013 ACC/AHA guideline release compared with LDL-C goals of <70mg/dL and <100mg/dL previously recommended by other professional societies. The single-system cohort study used medical records, laboratory results, and claims data (November 2012-October 2017) of adults with ≥1 claim for a statin, ≥1 ASCVD diagnosis in propensity score-matched analyses. Among 1938 patients (mean age 70 ± 11, 48% female) with ASCVD, the percentage on high-intensity statin therapy significantly increased over time: 24% in 2013, 34% 2014, 42% 2015, and 49% 2016 (P<.0001). The increase in high-intensity statin use was 13 to 22% higher among patients managed by subspecialists (cardiologist and endocrinologists) compared with those managed by primary care providers. Mean LDL-C level was slightly, but not significantly, lower in 2013 (80mg/dL) than in other years: 85mg/dL in 2014, 83mg/dL in 2015, and 82mg/dL in 2016. The proportion of patients reaching LDL-C goals ranged from 51% to 56% for the <70mg/dL target and 77% to 85% for the <100mg/dL target over time. High-intensity statin use among secondary prevention patients increased significantly immediately after the 2013 ACC/AHA guidelines release, primarily in those managed by subspecialists. However, the mean LDL-C and the proportion of patients reaching LDL-C < 70mg/dL and < 100mg/dL remain unchanged across comparison cohorts.