Abstract
BackgroundOnly limited research tracks United States trends in the use of statins recorded during outpatient visits, particularly use by patients at moderate to high cardiovascular risk.Methods and FindingsData collected between 1992 and 2002 in two federally administered surveys provided national estimates of statin use among ambulatory patients, stratified by coronary heart disease risk based on risk factor counting and clinical diagnoses. Statin use grew from 47% of all lipid-lowering medications in 1992 to 87% in 2002, with atorvastatin being the leading medication in 2002. Statin use by patients with hyperlipidemia, as recorded by the number of patient visits, increased significantly from 9% of patient visits in 1992 to 49% in 2000 but then declined to 36% in 2002. Absolute increases in the rate of statin use were greatest for high-risk patients, from 4% of patient visits in 1992 to 19% in 2002. Use among moderate-risk patients increased from 2% of patient visits in 1992 to 14% in 1999 but showed no continued growth subsequently. In 2002, 1 y after the release of the Adult Treatment Panel III recommendations, treatment gaps in statin use were detected for more than 50% of outpatient visits by moderate- and high-risk patients with reported hyperlipidemia. Lower statin use was independently associated with younger patient age, female gender, African American race (versus non-Hispanic white), and non-cardiologist care.ConclusionDespite notable improvements in the past decade, clinical practice fails to institute recommended statin therapy during many ambulatory visits of patients at moderate-to-high cardiovascular risk. Innovative approaches are needed to promote appropriate, more aggressive statin use for eligible patients.
Highlights
Coronary heart disease (CHD) remains the leading cause of morbidity and mortality in the United States and is associated with substantial economic cost [1]
Evidence-based practice guidelines focus on lowdensity lipoprotein cholesterol (LDL-C) as the primary target for risk reduction therapy and recommend that the intensity and target goals of LDL-C-lowering therapy should be adjusted to individual absolute risk for CHD [3]
We report national annual means of the rate of statin use by CHD risk category and corresponding 99% confidence intervals for the years 1992 through 2002. v2 tests examined the association of statin use with individual patient visit characteristics for combined 1995–2002 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) data
Summary
Coronary heart disease (CHD) remains the leading cause of morbidity and mortality in the United States and is associated with substantial economic cost [1]. While therapeutic lifestyle changes are integral to general risk reduction, drug treatment proves necessary for selected patients whose absolute risk is high and/or whose LDL-C is inadequately controlled with lifestyle modifications alone. Limited research tracks United States trends in the use of statins recorded during outpatient visits, use by patients at moderate to high cardiovascular risk. Using two large United States outpatient care surveys that have run for many years, they looked at information on how doctors prescribed these drugs to patients. They found that between 1992 and 2002 the proportion of visits by patients with high lipid levels during which statins were prescribed rose from 9% in 1992 to 49% in 2000 and fell to 36%. Other factors that led to lower prescribing of statins were younger patient age, female gender, African American background, and care by non-cardiologists
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