Statin Benefit Groups Research Articles

Potential impact of blood cholesterol guidelines on statin treatment in the U.S. population using interrupted time series analysis

BackgroundThe 2013 ACC/AHA Guideline was a paradigm shift in lipid management and identified the four statin-benefit groups. Many have studied the guideline’s potential impact, but few have investigated its potential long-term impact on MACE. Furthermore, most studies also ignored the confounding effect from the earlier release of generic atorvastatin in Dec 2011.MethodsTo evaluate the potential (long-term) impact of the 2013 ACC/AHA Guideline release in Nov 2013 in the U.S., we investigated the association of the 2013 ACC/AHA Guideline with the trend changes in 5-Year MACE survival and three other statin-related outcomes (statin use, optimal statin use, and statin adherence) while controlling for generic atorvastatin availability using interrupted time series analysis, called the Chow’s test. Specifically, we conducted a retrospective study using U.S. nationwide de-identified claims and electronic health records from Optum Labs Database Warehouse (OLDW) to follow the trends of 5-Year MACE survival and statin-related outcomes among four statin-benefit groups that were identified in the 2013 ACC/AHA Guideline. Then, Chow’s test was used to discern trend changes between generic atorvastatin availability and guideline potential impact.Results197,021 patients were included (ASCVD: 19,060; High-LDL: 33,907; Diabetes: 138,159; High-ASCVD-Risk: 5,895). After the guideline release, the long-term trend (slope) of 5-Year MACE Survival for the Diabetes group improved significantly (P = 0.002). Optimal statin use for the ASCVD group also showed immediate improvement (intercept) and long-term positive changes (slope) after the release (P < 0.001). Statin uses did not have significant trend changes and statin adherence remained unchanged in all statin-benefit groups. Although no other statistically significant trend changes were found, overall positive trend change or no changes were observed after the 2013 ACC/AHA Guideline release.ConclusionsThe 2013 ACA/AHA Guideline release is associated with trend improvements in the long-term MACE Survival for Diabetes group and optimal statin use for ASCVD group. These significant associations might indicate a potential positive long-term impact of the 2013 ACA/AHA Guideline on better health outcomes for primary prevention groups and an immediate potential impact on statin prescribing behaviors in higher-at-risk groups. However, further investigation is required to confirm the causal effect of the 2013 ACA/AHA Guideline.

Provider Adherence to Prescribing Guidelines for Statin Therapy.

Atherosclerotic cardiovascular disease (ASCVD) is a major contributor to nationwide morbidity, mortality, and healthcare costs in the United States. Over 92 million adults have at least one form of ASCVD, and annual costs for treatment are anticipated to surpass one trillion dollars within the next 15 years. The objective of this study was to evaluate the medication therapy of a population of adults in comparison to the American College of Cardiology/American Heart Association (ACC/AHA) recommendations for statin therapy for ASCVD risk reduction. The adult population receiving care from a group of hospital outpatient clinics was examined using a database query. Rates of ASCVD in a multicounty area were compared and provider adherence to current guidelines was assessed. Rural counties showed higher rates of ASCVD. Rates of statin medication prescribing for patients of each ACC/AHA statin benefit group ranged from 66.2% to 74.8%. Adherence to guidelines varied among counties and optimal adherence was not achieved. Providers were also more likely to prescribe statin medications to men than women within each group regardless of risk. These findings can assist nurse practitioners and other providers in addressing areas of nonadherence to guidelines.

Assessment of the Efficacy of Lowering LDL Cholesterol with Rosuvastatin 10 mg in Four Korean Statin Benefit Groups as per ACC/AHA Guidelines (NewStaR4G).

The American College of Cardiology and American Heart Association (ACC/AHA) guidelines identified four statin benefit groups on the basis of atherosclerotic cardiovascular disease risk reduction and proposed statin therapy by evidence-based intensity. Although these guidelines used randomized controlled trials with hard outcomes as exclusive evidence for its recommendations, a limited number of studies conducted in Asian countries makes its application of treatment strategy, intensity, and statin doses uncertain in these population. This prospective, multicenter study aimed to evaluate the efficacy of rosuvastatin 10 mg in the four statin benefit groups requiring high- or moderate-intensity statin therapy according to the ACC/AHA guidelines in the Korean population. The primary endpoint was percentage reduction in low-density lipoprotein (LDL) cholesterol. Secondary endpoints were percentage reduction in other lipids and achievement of ≥50% reduction in LDL cholesterol. Rosuvastatin 10 mg lowered LDL cholesterol by 61.4 mg/dL, a 44.9% decrease from baseline after eight weeks. Reduction of LDL cholesterol ≥50% was achieved in 46.3% of patients. Rosuvastatin 10 mg was generally well tolerated. In the Korean population, rosuvastatin 10 mg was favorable and tolerant in lowering LDL cholesterol in the four statin benefit groups requiring high- or moderate-intensity statin therapy according to the ACC/AHA guidelines.

Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India

To evaluate concordance to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline on treatment of blood cholesterol for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. Concordance to 2013 ACC/AHA guideline was assessed by retrospectively analyzing statin therapy prescribing practice as per ASCVD risk score in four statin-benefit groups in 23,295 patients aged 40-79 years from health facilities across India between 2017 and 2018. Mean (±SD) age of patients was 58.9 (±9.2) years; 62% were men; 60% (n=14,070) had clinical ASCVD. Among patients without ASCVD (n=7,122), 3.9% (n=278) had low-density lipoprotein-cholesterol (LDL-C) ≥190 mg/dL, 94.0% (n=6,694) had diabetes mellitus and 2.1% (n=150) patients had 10-year ASCVD risk ≥7.5%. Among 18,795 patients (81%) eligible for high-intensity statins, only 34% were concordant whereas 63% were treated with moderate-intensity statins. Among 2,290 patients eligible for moderate-intensity statins, 76% were concordant and 18% received high-intensity statins. Among patients with ASCVD ( 7.5%, 83% remained under-treated. Most patients (82%) with LDL-C >190 mg/dL were prescribed with moderate-intensity statins. Most patients were receiving statins at dose non-concordant to 2013 ACC/AHA guideline, reflecting gaps in real-world practice of prescribing statins for primary and secondary prevention of ASCVD. Addressing care gaps and promoting compliance to optimize statin therapy will help reduce cardiovascular disease, especially in high-risk population among South Asians.

PCV5 PREVALENCE OF FOUR STATIN BENEFIT GROUPS IN A POPULATION OF THE CARIBBEAN REGION OF COLOMBIA

To estimate the prevalence of four Statin Benefit Groups (SBG) according to the 2018 ACC/AHA Multisociety Guideline on the Management of Blood Cholesterol, in a population of the Caribbean region of Colombia enrolled to DTC program Mutual SER-EPS in 2015 Data on a history of hyperlipidemia was collected by study investigators at including adults patients enrolled to DTC program Mutual SER-EPS in 2015 (N = 64,667) with ICD-10 diagnosis of hyperlipidemia (E78), or with a personal history of hyperlipidemia; or with abnormal lipid profile; or patients under treatment with lipid-lowering drugs. The four SBG were comprised adult patients ≥21 years of age with clinical atherosclerotic cardiovascular disease (ASCVD) (SBG1); adults ≥21 years of age with LDL-C ≥190 mg/dL (not due to secondary modifiable causes) (SBG2); adults aged 40 to 75 years without ASCVD, but with diabetes and with LDL-C 70 to 189 mg/dL (SBG3); and adults ages 40 to 75 years without ASCVD or diabetes, with LDL-C 70 to 189 mg/dL, and an estimated 10-year risk for ASCVD of ≥ 20% as determined by the Framingham Risk Score (SBG4). The prevalence of statin use by SBG and factors associated with statin use were estimated. The prevalence of SBG1, SBG2, SBG3 and SBG4 in patients enrolled to DTC program Mutual SER-EPS in 2015 were 4.6% (2,985), 0.5% (337), 2.5% (1,633) and 1.3% (891), respectively. The prevalence of statin use in SBG1, SBG2, SBG3 and SBG4 were 69.1% (2,064), 40.6% (137), 47% (768) and 59.1% (463), respectively. Arterial hypertension (OR: 2.70; 95% IC 1.70-4.28) and personal history of ASCVD (OR: 3.43; 95% IC 2.15-5.46) were very significantly associated with statin use. The prevalence of SBG and statin use in patients enrolled to DTC program Mutual SER-EPS in 2015 were 9% (5,846) and 58.7% (3,432), respectively.

Atherosclerotic cardiovascular disease risk assessment and predictors of statin use in Filipino-American Women.

Race and gender disparities in the context of appropriate treatment with lipid-lowering therapies do exist. The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines outlined four groups, three for primary prevention and one for secondary prevention, whom would benefit from statin therapy to target atherosclerotic cardiovascular disease (ASCVD). The application of these recommendations in Filipino women living in the United States is unknown; however, this population is known to have elevated cardiovascular risk. Socio-economic and clinical characteristics that predict statin utilization of this Asian American subgroup need to be explored. This was an exploratory analysis of data collected during a cross-sectional study of Filipino-American Women (FAW). The Pooled Cohort equation was used to estimate 10-year ASCVD risk. Bivariate analysis was employed to determine the association between statin treatment and clinical and socio-economic factors. Data were analysed using SAS® 9.4; statistical significance was set at P<0.05. A total of 384 women (mean age 56.3years) were included in the original study, and the average 10-year ASCVD risk was 3.5±3.7%. Upon applying the 2013 ACC/AHA guidelines, 97 FAW were categorized into one of the primary prevention groups. Women considered to benefit from a statin based on the guideline criteria but were not prescribed a statin were considered the not statin treated group (n=55). From the original cohort, 93 FAW reported current statin therapy use and were categorized as statin treated. The clinical characteristics associated with not being statin treated were as follows: untreated blood pressure (P=0.012), higher diastolic blood pressure (P=0.015), higher total cholesterol (P<0.001), higher triglycerides (P=0.041), higher low-density lipoprotein (P<0.001) and higher glucose (P=0.011). The socio-economic factor associated with not being statin treated was having two or more insurance payers (P=0.005). Overall, this population had a waist circumference and body mass index (BMI) that exceeds guidelines for Asian women (31.5 or 80cm). Predictors of statin utilization in FAW are not well documented in the literature. These findings emphasize room for improvement for the prescribing of statins in primary prevention for this study population. Applying culturally appropriate screening strategies to identify cardiovascular risk factors early such as BMI or waist circumference may assist with quantifying patients into one of the statin benefit groups if eligible.

Efficacy of Low-dose (10 mg) Rosuvastatin in Korean 4 Statin Benefit Groups Per 2013 ACC/AHA Guideline

Efficacy of Low-dose (10 mg) Rosuvastatin in Korean 4 Statin Benefit Groups Per 2013 ACC/AHA Guideline

Abstract TP514: The Effect of Statin Adherence on Cardiovascular Outcomes After Ischemic Stroke in Statin Benefit Group: A Nested Case-Control Study

Backgrounds: Irrespective of the indication for statin, statin adherence after ischemic stroke was associated with better clinical outcome. We studied the association between statin adherence and recurrent cardiovascular (CV) events among the patients with acute ischemic stroke and statin benefit. Methods: Using Comprehensive Registry Collaboration for Stroke in Korea (CRCS-K), patients with acute ischemic stroke were identified. Statin benefit was defined using the secondary prevention guidelines of American Stroke Association in 2014. The data for statin prescription after discharge were obtained from National Health Insurance Services (NHIS) claim data by matching with CRCS-K. Statin adherence was measured by the medication possession ratio (MPR), which was dichotomized, setting a threshold of MPR (&lt;80%) to identify patients who were nonadherent. A nested case-control design was used to evaluate the occurrence of recurrent stroke, myocardial infarction, and all-cause mortality for 1 year after discharge. Each case was matched to 4 controls by age, sex, initial stroke severity and registry entry time. Adjusted conditional logistic regression models were used to estimate the odds ratio (OR) of CV events. Results: Among 11,768 patients in NHIS-CRCS-K matching database, 5,504 patients were the statin benefit group and prescribed with statin on discharge. Overall MPR for 1 year after discharge was 73.1%. Overall CV events for 1 year were 569, which was more prevalent in low adherence group. (MPR &lt;80%, 18.0% vs. ≥80%, 6.5%, p&lt;0.0001) In nested case-control data set, lower adherence to statin was associated with a higher risk of CV events compared with higher adherence (adjusted OR 1.496 [1.174-1.904]) after adjusting hypertension, diabetes mellitus, atrial fibrillation, history of stroke, history of antiplatelet drug use and discharge modified Rankin Scale score. Statin discontinuation was associated with higher risk compared with adequate statin prescription. (adjusted OR 2.075[1.622-2.655]) Conclusion: Adequate statin adherence in the patients with acute ischemic stroke and statin benefit was significantly associated with recurrent CV events.

Trends in Statin Use 2009\u20132015 in a Large Integrated Health System: Pre- and Post-2013 ACC/AHA Guideline on Treatment of Blood Cholesterol

PurposeImplementation of the 2013 ACC/AHA cholesterol treatment guideline is likely to vary by statin benefit group. The aim of this study was to document trends in statin use before and after introduction of the ACC/AHA guideline.MethodsWe conducted a retrospective study with annual cohorts from 2009 to 2015 among members of Kaiser Permanente Southern California aged ≥ 21 years. Members were categorized into four mutually exclusive statin benefit groups: atherosclerotic cardiovascular disease (ASCVD), LDL-C ≥ 190 mg/dL in the last year, diabetes (aged 40–75 years), and 10-year ASCVD risk ≥ 7.5% (aged 40–75 years).ResultsThe cohorts ranged from 1,993,755 members in 2009 to 2,440,429 in 2015. Approximately 5% of patients had ASCVD, 1% had LDL-C ≥ 190 mg/dL, 6% had diabetes, and 10% had a 10-year ASCVD risk ≥ 7.5% each year. Trends in statin use were stable for adults with ASCVD (2009 78%; 2015 80%), recent LDL-C ≥ 190 mg/dL (2009 45%; 2015 44%), and diabetes (2009 74%; 2015 73%), but increased for patients with 10-year ASCVD risk ≥ 7.5% (2009 36%; 2015 47%). High-intensity statin use also increased 142% and 54% among patients with LDL-C ≥ 190 mg/dL and those with ASCVD ≤ 75 years of age, respectively. Moderate-to-high intensity statin utilization increased over 50% among those with a 10-year ASCVD risk ≥ 7.5%.ConclusionsStatin use increased substantially among patients with 10-year ASCVD risk ≥ 7.5% and use of appropriate statin dosage increased in each of the four statin benefit groups between 2009 and 2015; however, there is room for improvement.

Abstract 35: Trends in Statin Use and Adherence and the Impact of the 2013 Cholesterol Guidelines

Background: In 2013, the ACC/AHA updated the cholesterol treatment guidelines. At the time, it was estimated that an additional 13 million Americans would quality for statin therapy. To date, the real-world implications of this guideline change have not been well studied. This study aims to better understand trends in statin use and adherence, by gender, and the impact of guideline change. Methods: This is a retrospective, observational study using medical and pharmacy claims from 2009 to 2014 from a large, national, commercial insurer. Considering all beneficiaries aged 18-65 with ≥1 year of continuous enrollment, we created annual cross sectional populations of statin-eligible patients and divided them into 3 statin benefit groups (SBG). In descending order of risk, the groups were: (1) atherosclerotic cardiovascular disease (ASCVD); (2) diabetes and (3) hyperlipidemia. Patients were assigned to the highest risk group that they qualified for. Results: Statin use rates among those with ASCVD increased until 2012 and then plateaued (Figure 1a ). Use rates among those with diabetes, were flat until 2011 and then increased. Use rates among those with hyperlipidemia steadily rose from 2009-2014. Statin adherence rates among those with ASCVD increased from 2009-2014 ( Figure 1b ). Adherence rates among those with diabetes, decreased from 2009-2011 and then rose significantly from 2011-2014. Adherence rates among those with hyperlipidemia also rose steadily from 2009-2014. The most significant gender gap in treatment, for both use and adherence, was between men and women with ASCVD. There was with little change in this treatment gap, in any risk group, over the time period observed. Conclusion: The 2013 cholesterol guidelines have not yet had a significant effect on statin use or adherence. Recently improving trends in statin use and adherence, especially among patients with diabetes, appear to predate the 2013 guideline change. A significant gender gap in statin treatment remains, especially among those in the highest risk group.

Trends and disparities in statin use and low-density lipoprotein cholesterol levels among US patients with diabetes, 1999–2014

AimsThe 2013 American College of Cardiology/American Heart Association Guideline defined patients with diabetes aged 40–75 years as a major statin benefit group. We explored the temporal trends and disparities in statin utilization and LDL-C levels among patients with diabetes aged 40–75 years. MethodsA total of 4860 patients from the National Health and Nutrition Examination Survey 1999 to 2014 were included in this study. Differences in statin use and LDL-C levels were explored by patient characteristics. ResultsFrom 1999–2002 to 2011–2014, the prevalence of statin use increased from 26.2% to 49.5% (Ptrend < 0.001). This was accompanied by a continuous decrease in the mean LDL-C level (from 115.8 mg/dL to 103.3 mg/dL, Ptrend < 0.001). The use of guideline-defined high-potency statin medications (atorvastatin and rosuvastatin) remained largely unchanged (from 14.0% to 17.9%, Ptrend = 0.55). Statin utilization increased with age. Women and blacks were 10% and 16% less likely to receive statin treatment compared with men and whites, respectively. In comparison with other statin treatment, use of atorvastatin or rosuvastatin was associated with average LDL-C reduction of 8.0 mg/dL. LDL-C levels were significantly higher among women and black patients. After adjustment for potential confounders, age and Hispanic-white differences in statin use and LDL-C levels were substantially attenuated. ConclusionsDespite a steady increase in statin use during the 16-year study period, statin therapy remains underutilized in certain subgroups of patients. Confounding factors related to healthcare utilization account for some of the disparities in statin use and LDL-C levels.

Clinical pharmacist understanding of the 2013 American College of Cardiology/American Heart Association cholesterol guideline

Clinical pharmacists are frequently involved in the management of dyslipidemia, yet clinical pharmacists' knowledge, awareness, and the level of agreement with the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol guideline are unknown. The objective of the study was to examine clinical pharmacists' knowledge, awareness, and the level of agreement with the 2013 ACC/AHA cholesterol guideline. We administered a validated questionnaire via an online survey that was electronically mailed to clinical pharmacists. We compared responses between those in practice for ≤ 10 and those in practice for > 10years, and according to practice specialty. The response rate was 11% (314 of 2845). Most respondents were from the Midwestern and Southeastern US, in practice for ≤ 10years, and practiced in family practice/primary care. Nearly all (92%) respondents had read the guideline and 72% were able to identify the 4 statin benefit groups. Notable knowledge gaps included recalling the 4 outcomes of the 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimator (41.4%), understanding differences between the Framingham Risk Score and the ASCVD risk estimator (33.7%), and monitoring lipids after initiating a statin (41.1%). More knowledge gaps were identified in those practicing for > 10years and who specialized in internal medicine. The use of the ASCVD risk estimator was high; yet nearly half (44.2%) were concerned whether the ASCVD risk estimator would overestimate 10-year ASCVD risk. Although most clinical pharmacists had read the 2013 ACC/AHA cholesterol guideline, several knowledge gaps were identified, especially among those with more experience and those practicing in internal medicine. Targeted education efforts are needed to address these gaps.

Coronary artery calcium score plays an important role for cardiovascular risk stratification in the statin benefit groups of asymptomatic individuals

BackgroundThe purpose of this study was to describe and analyze the relationship between statin benefit groups based on statin-intensity class of drugs and coronary artery calcium score (CACS) using multidetector computed tomography (MDCT) in an asymptomatic Korean population.MethodsA total of 3914 asymptomatic individuals (mean age: 55 ± 10 years; male: female = 2649: 1265) who underwent MDCT for health examination between January 2009 and December 2012 were retrospectively enrolled. They were categorized into three groups based on statin-intensity class of drugs (high-intensity (n = 1284, 32.8%); moderate-intensity (n = 1602, 40.9%) and low-intensity (n = 931, 23.8%) statin therapy groups) according to the American College of Cardiology (ACC)/American heart Association (AHA) 2013 guideline and the relationship between CACS and statin benefit group was analyzed. The statin benefit group was defined as individuals who should be considered moderate- and high-intensity statin therapy.ResultsTen-year atherosclerotic cardiovascular disease (ASCVD; 12.6 ± 5.3% vs. 2.9 ± 1.9%, p < 0.001) and CACS (98 ± 270 vs. 3 ± 2, p < 0.001) were significantly higher in the high-intensity group compared to the moderate-intensity statin therapy group. In the high-intensity statin therapy group, age [odds ratio: 1.299 (1.137–1.483), p < 0.001], male gender [odds ratio: 44.252 (1.959–999.784), p = 0.001], and fasting blood glucose [odds ratio: 1.046 (1.007–1.087), p = 0.021] were independent risk factors associated with CACS ≥300 on multivariate logistic regression analysis.ConclusionsCACS on MDCT might be an important complementary tool for cardiovascular disease risk stratification. This study indicates that individualization of statin therapy as well as lifestyle modification will be useful in asymptomatic individuals, especially those in whom high-intensity statin therapy is required.

Role of Non-Statins, LDL-C Thresholds, and Special Population Considerations: A Look at the Updated 2016 ACC Consensus Committee Recommendations.

The 2013 ACC/AHA Cholesterol guidelines was a major paradigm shift in the management and treatment of dyslipidemia. The new guidelines outlined "statin benefit groups," highlighted weighing the benefit versus risks of statin therapy ("net benefit"), and discussed the importance of shared decision making between patients and providers in primary prevention. While there was widespread agreement on the main groups benefiting from statin therapy, there was significant controversy regarding LDL-C goals and thresholds, the role of non-statin therapy, and the use of statins in specific populations. The goal of this review is to understand the rationale for the updated 2016 ACC Expert Consensus on Non-Statins and to contrast it with the 2015 NLA Recommendations on the Management of Dyslipidemia. The findings of the ACC Expert Consensus Panel were largely influenced by the results of several new clinical trials using non-statin therapy in combination with moderate to high intensity statin therapy. The IMPROVE-IT trial demonstrated that ezetimibe on top of statin therapy lowered ASCVD risk in patients with acute coronary syndromes whose LDL was driven below the previous LDL-C target of <70mg/dL. In addition, preliminary data assessing the safety of evolocumab and alirocumab on top of statin therapy suggested possible large reductions in ASCVD risk in post hoc analysis. Both the 2016 ACC Consensus Recommendations and the 2015 NLA Recommendations emphasize the importance of maximally tolerated statin therapy, the use of adjunctive non-statin LDL lowering therapy, and the use of LDL-C goals and thresholds to guide intensification of LDL lowering therapy. Although there are some important differences between the ACC Consensus and NLA recommendations in terms of treatment of special populations (i.e., CHF) and on the use of non-HDL-C goals and thresholds, both guidelines support a role for ezetimibe, bile acid sequestrants, and PCSK-9 inhibitors in patients on maximum tolerated statin therapy. The recent positive results of the FOURIER trial gives additional support to the non-statin recommendations of both the ACC and NLA.

Initiation Patterns of Statins in the 2Years After Release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Management Guideline in a Large US Health Plan.

BackgroundThe purpose of this study was to characterize changes in statin utilization patterns in patients newly initiated on therapy in the 2 years following the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline in a large US health plan population.Methods and ResultsThis retrospective, observational study used administrative medical and pharmacy claims data to identify patients newly initiated on statin therapy over 4 quarters prior to and 8 quarters following the release of the guideline (average N/quarter=3596). Patients were divided into the 4 statin benefit groups (SBGs) based on risk factors and laboratory lipid levels as defined in the guideline: SBG1 (with atherosclerotic cardiovascular disease [ASCVD]; N=1046/quarter), SBG2 (without ASCVD, with low‐density lipoprotein cholesterol ≥190 mg/dL; N=454/quarter), SBG3 (without ASCVD, aged 40–75 years, with diabetes mellitus, low‐density lipoprotein cholesterol 70–189 mg/dL; N=1391/quarter), SBG4 (no ASCVD or diabetes mellitus, age 40–75 years, low‐density lipoprotein cholesterol 70–189 mg/dL, estimated 10‐year ASCVD risk of ≥7.5%; N=705/quarter). Demographic variables, statin utilization patterns, lipid levels, and comorbidities were analyzed for pre‐ and postguideline periods. Postguideline, gradually increased high‐intensity statin initiation occurred in SBG1, SBG2, and in SBG3 patients with 10‐year ASCVD risk ≥7.5%. Moderate‐ to high‐intensity statin initiation gradually increased among SBG4 patients. Recommended‐intensity statin choice changed to a greater degree among patients treated by specialty care physicians. Regarding sex, target‐intensity statin initiation was lower in women in all groups before and after guideline release.ConclusionsPrescriber implementation of the guideline recommendations has gradually increased, with the most marked change in the increased initiation of high‐intensity statins in patients with ASCVD and in those treated by a specialist.

Statin Utilization Among Human-Immunodeficiency Virus (HIV)-Infected Individuals Based on the 2013 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guideline

Background There are limited data on statin utilization among HIV+ individuals in real-world settings using the new 2013 ACC/AHA blood cholesterol guideline. We aimed to determine the proportion of appropriate statin use based on this guideline in a large urban outpatient center.Methods Chart review of 1087 HIV+ patients 40 years and over from the Washington University Virology Clinic was done from January 1 to December 31, 2015. Patients were classified according to the 4 statin benefit groups from the guideline: (1) those with clinical atherosclerotic cardiovascular disease (ASCVD); (2) those with primary hyperlipidemia (LDL-C ≥ 190 mg/dL); (3) individuals 40 to 75 years of age with diabetes and an LDL 70 to 189 mg/dL without ASCVD; and (4) those 40 to 75 years of age without ASCVD or diabetes, with LDL 70 to 189 mg/dL, and with a 10-year ASCVD risk of ≥ 7.5%. Factors that may influence receipt of statin were analyzed using the chi-square test, t-test, or the Wilcoxon rank-sum test when applicable.ResultsThe median age of patients was 51 years and the majority were male (71%), black (67%), receiving antiretroviral therapy (98%), had HIV RNA ≤ 20 copies/ml (87%) and median CD4 count of 523 cells/µL. Overall, 450 (41%) patients had an indication for statin use, with the majority classified under group 4. However, only 160 (36%) were on statins, of whom 89% were on appropriate doses. The percentages of patients on statins were only 36%, 44%, 49%, and 30% for groups 1, 2, 3, and 4, respectively. There was no significant difference between those who were and were not on statins in terms of CD4 count and pill burden. The rates of ritonavir, cobicistat, and efavirenz use were also similar between the two groups. In group 4, however, those who had viral suppression were more likely to be prescribed a statin compared with those who had no viral suppression (95% vs. 87%, P = 0.031).Conclusion Two-thirds of our patients were not prescribed statins despite a strong indication for it based on the new guideline. Our finding stresses the critical need to address this gap among HIV+ individuals. It also emphasizes the need to prioritize ASCVD prevention in the care of the aging HIV-infected population.Disclosures All authors: No reported disclosures.

Application of the 2013 American College of Cardiology/American Heart Association Cholesterol Guideline to the Korean National Health and Nutrition Examination Surveys from 1998 to 2012.

BackgroundThe 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline for the treatment of blood cholesterol recommends statin therapy for individuals at high risk of atherosclerotic cardiovascular disease (ASCVD). The aim of this study was to investigate serial trends in the percentages of Korean adults considered eligible for statin therapy according to the new ACC/AHA cholesterol guideline.MethodsData from the Korean National Health and Nutrition Examination Survey (KNHANES) I (1998, n=7,698), II (2001, n=5,654), III (2005, n=5,269), IV (2007 to 2009, n=15,727), and V (2010 to 2012, n=16,304), which used a stratified, multistage, probability sampling design, were used as representative of the entire Korean population.ResultsThe percentage of adults eligible for statin therapy according to the ACC/AHA cholesterol guideline increased with time: 17.0%, 19.0%, 20.8%, 20.2%, and 22.0% in KNHANES I, II, III, IV, and V, respectively (P=0.022). The prevalence of ASCVD was 1.4% in KNHANES I and increased to 3.3% in KNHANES V. The percentage of diabetic patients aged 40 to 75 years with a low density lipoprotein cholesterol levels of 70 to 189 mg/dL increased from 4.8% in KNHANES I to 6.1% in KNHANES V. People with an estimated 10-year ASCVD risk ≥7.5% and aged 40 to 75 years accounted for the largest percentage among the four statin benefit groups: 9.1% in KNHANES I and 11.0% in KNHANES V.ConclusionApplication of the 2013 ACC/AHA guideline has found that the percentage of Korean adults in the statin benefit groups has increased over the past 15 years.

Four Statin Benefit Groups Defined by The 2013 ACC/AHA New Cholesterol Guideline are Characterized by Increased Plasma Level of Electronegative Low-Density Lipoprotein.

Significantly higher cytotoxic and thrombogenic human electronegative low-density lipoprotein (LDL), or L5, has been found in patients with stable coronary artery disease and acute coronary syndrome. We hypothesized that the statin-benefit groups (SBGs) defined by the new cholesterol guideline were of higher electronegative L5. In total, 62 hyperlipidemia patients (mean age 59.4 ± 10.5, M/F 40/22) were retrospectively divided into SBGs (n = 44) and N-SBGs (n = 18). The levels of complete basic lipid panel, biochemical profile and electronegative L5 of each individual were obtained before and after rosuvastatin 10 mg/day for 3 months. After 3 months' statin therapy, significant reduction of total cholesterol, LDL-C and triglyceride were demonstrated (all p-values < 0.05), with 38.4% LDL-C reduction. The percentage of L5 was significantly reduced by 40.9% (from 4.4% to 2.6%) after statin therapy (p = 0.001). Regarding absolute L5 concentration, derived from L5% multiplied by LDL-C, there was approximate 63.8% reduction (from 6.3 mg/dL to 2.3 mg/dL) of absolute L5 (p < 0.001) after statin treatment. Notably, while plasma LDL-C levels were similar between SBGs and N-SBGs (152.8 ± 48.6 vs. 146.9 ± 35.0 mg/dL), the SBGs had significantly elevated L5% (5.2 ± 7.4% vs. 2.6 ± 1.9%, p = 0.031) and higher absolute L5 concentration (7.4 ± 10.4 vs. 3.7 ± 3.1 mg/dL, p = 0.036). Linear regression showed the significantly positive correlation between the plasma L5 concentration and the 10-year cardiovascular risk by pooled cohort equation (r = 0.297, p < 0.05). The four SBGs defined by the 2013 ACC/AHA new cholesterol guideline tend to have increased atherogenic electronegative L5. Statin therapy can effectively reduce the electronegative L5 of these four major SBGs.

PS 11-02 THE CORONARY ARTERY CALCIUM SCORE PLAYS AN IMPORTANT ROLE FOR CARDIOVASCULAR RISK STRATIFICATION IN THE STATIN BENEFIT GROUP OF ASYMPTOMATIC INDIVIDUALS

Objective: Today's guideline for the assessment of cardiovascular risks and the treatment of blood cholesterol to reduce atherosclerotic cardiovascular diseases (ASCVD) is demonstrated. However, there is a lack of information about available data regarding the relationship between coronary artery calcium score (CACS) using multidetector computed tomography (MDCT) and statin-intensity class of drugs in asymptomatic healthy individuals. Design and Method: According to the new guidelines of 2013, all participants (n = 3,817, male: female 2,649: 1,265, mean age: 55 ± 10 years; age 40 to 79 years) in the present study were categorized into three groups by the statin-intensity class of drugs: high-intensity (n = 1,284, 32.8%); moderate-intensity (n = 1,602, 40.9%) and low-intensity statin therapy group (n = 931, 23.8%). We analyzed the relationship between CACS and the statin benefit group. The statin benefit group was defined as individuals who should be considered moderate- and high-intensity statin therapy. Results: The ten-year ASCVD (12.6 ± 5.3% vs. 2.9 ± 1.9%, P < 0.001) and CACS (98 ± 270 vs. 3 ± 2, P < 0.001) were significant higher in the high-intensity group than in moderate-intensity statin therapy group. In the high-intensity statin therapy group, age [odds ratio: 1.299 (1.137–1.483), P < 0.001], male gender [odds ratio: 44.252 (1.959–999.784), P = 0.001], and fasting blood glucose [odds ratio: 1.046 (1.007–1.087), P = 0.021] were independent risk factors associated with CACS ≥ 300 by multivariate logistic regression analysis. Conclusions: CACS as well as global risk scores plays an important role as a complementary tool for the cardiovascular risk stratification and more specific strategies of statin therapy should be considered in an asymptomatic individual, especially if a high-intensity statin therapy is required.

Prevalence and Factors Associated With Statin Use Among a Nationally Representative Sample of US Adults: National Health and Nutrition Examination Survey, 2011-2012.

The 2013 American College of Cardiology/American Heart Association guidelines recommend statins for adults age ≤75 years who have clinical atherosclerotic cardiovascular disease (IA) and adults age 40 to 75 years with diabetes mellitus and LDL-C 70-189 mg/dl (IA). Our aim was to estimate the prevalence and likelihood of statin use among selected statin benefit groups. Using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2012, we examined 5319 adults age ≥20 years. We estimated weighted frequencies and prevalence of statin use for adults with diabetes mellitus and dyslipidemia (or low-density lipoprotein cholesterol ≥70 mg/dL), defined as statin benefit group 1 (SBG1); and for adults with atherosclerotic cardiovascular disease, defined as statin benefit group 2 (SBG2). We constructed a logistic regression model to estimate odds of statin use in SBG1. Overall, an estimated 38.6 million Americans are on a statin. In adjusted models, uninsured and Hispanic adults were less likely to be on a statin compared with white adults; 59.5% (95% confidence interval [CI]: 53.0-66.1) of all adults in SBG1, 58.8% (95% CI: 51.5-66.1) of adults age 40 to 75 in SBG1, and 63.5% (95% CI: 55.6-71.4) of all adults in SBG2 were on a statin. Although the prevalence of statin use has increased over time, Hispanic ethnicity and lack of insurance remain barriers to statin use. Black-white racial disparities were not significant. Our study provides a baseline estimate of statin use in the noninstitutionalized population just prior to introduction of the new guidelines and provides a reference for evaluating the impact of the new guidelines on statin utilization.