Prevalence of the American College of Cardiology/American Heart Association statin eligibility groups, statin use, and low-density lipoprotein cholesterol control in US adults using the National Health and Nutrition Examination Survey 2011–2012

Abstract

The 2013 American College of Cardiology/American Heart Association Cholesterol Management Guideline identifies 4 statin-eligible groups: (1) known atherosclerotic cardiovascular disease (ASCVD) aged ≥21years, (2) low-density lipoprotein cholesterol (LDL-C) ≥ 190mg/dL (4.9mmol/L) aged ≥21years, (3) diabetes mellitus aged 40 to 75years with LDL-C 70 to 189mg/dL (1.8-4.9mmol/L), or (4) ≥7.5% 10-year ASCVD risk aged 40 to 75years with LDL-C 70 to 189mg/dL (1.8-4.9mmol/L). We examined the number of statin-eligible US adults, statin use, LDL-C goal attainment, and adherence to lifestyle management. We identified subjects from the US National Health and Nutrition Examination Survey 2011-2012 in the 4 statin-eligible groups, proportion on statin, proportion at recommended LDL-C levels using National Lipid Association goals (<70mg/dL [1.8mmol/L] for very high risk and <100mg/dL [2.6mmol/L] for others), and adherence to lifestyle measures. Of 5206 adults (representing 219 million), 1677 adults representing 62.6 million adults fit into 1 of the 4 statin-eligible groups. Statin use was 63.7% for the ASCVD, 61.4% for the LDL-C ≥ 190mg/dL (4.9mmol/L), 43.2% for the diabetes mellitus, and 27.2% for the 10-year risk ≥7.5% groups. Of those on statins with LDL-C measured, 79.7%, 98.0%, 42.3%, and 46.8% were not at LDL-C goal. Adherence to recommended <6% calories from saturated fat ranged from 3.3% to 6.4% and ≥40minutes of physical activity ≥3 times a week from 54.7% to 65.1% across statin-eligible groups. Many US adults eligible to receive statins based on American College of Cardiology/American Heart Association guidelines are not taking statins, and LDL-C levels still remain suboptimal.