Abstract
BackgroundEuropean clinical guidelines recommend a low-density lipoprotein cholesterol (LDL-C) goal of < 70 mg/dL. Statin use varies and past studies suggest low rates of real-world goal attainment. This study describes LDL-C goal attainment among atherosclerotic CV disease (ASCVD) patients with various utilization patterns of moderate- or high-intensity statins in routine care.MethodsThis retrospective cohort study used electronic medical records data from the QuintilesIMS® Disease Analyzer (> 2 million individuals annually) to identify ASCVD (coronary atherosclerosis, stable/unstable angina, myocardial infarction, ischemic stroke, transient ischemic attack, aneurysm, peripheral artery disease) patients on moderate-/high-intensity statin in Germany. Proportion of patients with LDL-C < 70 mg/dL was determined using the lowest LDL-C value for each patient (index) in 2012, 2013, and 2014, while on statin. Treatment patterns were assessed for patients with at least 1 year of post-index follow-up. Results were stratified by year and treatment pattern [no change, switch, dose up-/down-titration, discontinuation (≥ 90 day gap)].ResultsIn > 14,000 patients assessed in each year (mean age 71 years, 35% female, 8–12% taking high-intensity statins), approximately 80% had LDL-C ≥ 70 mg/dL. Treatment patterns were assessed for most (88–93%) patients. Approximately 79–81% of patients made no change to statin regimens, 1% switched statins, 14–16% discontinued; 1% of moderate-intensity patients up-titrated, and 3% of all patients down-titrated. LDL-C goal attainment in these treatment pattern groups was 20, 16–24, 17, 11–14, and 17–19%, respectively.ConclusionsMajority of ASCVD patients had LDL-C ≥ 70 mg/dL while on moderate-/high-intensity statins. Despite low LDL-C goal attainment, few patients changed their treatment regimens.
Highlights
The benefit of lowering low-density lipoprotein cholesterol (LDL-C) is well documented in patients with hyperlipidemia, with strong evidence of decreases in both all-cause mortality and the occurrence of major cardiovascular (CV) outcomes [1,2,3,4,5]
In actual practice, treatment modifications rarely occurred in the atherosclerotic CV disease (ASCVD) population, even in light of laboratory assessments indicating that the majority of patients using moderate-/high-intensity statins are not achieving LDL-C goals
Our study suggests that approximately 80% of patients with ASCVD who use moderate- or high-intensity statins do not achieve the guideline-recommended LDL-C goal of < 70 mg/dL
Summary
The benefit of lowering low-density lipoprotein cholesterol (LDL-C) is well documented in patients with hyperlipidemia, with strong evidence of decreases in both all-cause mortality and the occurrence of major cardiovascular (CV) outcomes [1,2,3,4,5] Much of this evidence has come from clinical trials of moderate and intensive statin therapy in patients with atherosclerotic cardiovascular disease (ASCVD) who are generally considered to be at high risk of cardiovascular events, as well as in patients without prior CV history. Statin intolerance and other factors may lead to treatment discontinuation, switching among statin agents, dose adjustments, or the need for augmentation of the statin regimen with additional therapies These changes are common, and have the potential to impact real-world LDL-C goal attainment and the therapeutic benefits that are achieved by statin users outside of clinical trials [9,10,11,12,13]. Despite low LDL-C goal attainment, few patients changed their treatment regimens
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