Use Of Statins In Primary Prevention Research Articles

Trends in statin use for the primary prevention of atherosclerotic cardiovascular disease among US adults by demographic characteristics, 1999-2020.

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality worldwide. Statins, which are effective in preventing ASCVD, are underused, particularly for primary prevention. This study examined trends in statin use for primary ASCVD prevention from 1999 to 2020, focusing on demographic variations. Utilizing data from the National Health and Nutrition Examination Survey, the present study includes individuals aged 18 years and older who had a greater than 10% risk of ASCVD over 10 years, and excluded patients with existing ASCVD. Subgroup analyses by demographic categories were performed. We calculated the changes in statin usage and used linear and quadratic tests to assess the linear and nonlinear trends in those changes. A total of 10,037 participants were included. Statin usage increased from 16.16% in 1999 to 36.24% in 2010, and 41.74% in 2020 (quadratic P-value < 0.001). In the 18-44 years age group, statin usage increased from 2.52% in 1999 to 8.14% in 2020 (linear P-value = 0.322), showing no significant linear trend. In the "never-married" group, statin usage increased from 19.16% in 1999 to 30.05% in 2020 (linear P-value = 0.256). Statin usage has shown a positive trend among populations requiring primary prevention for ASCVD. Currently, health policies are proving effective. However, the overall statin usage rate remains less than 50%. Additionally, young and never-married individuals should also receive special attention regarding statin usage as primary treatment for ASCVD.

Sex-based utilization of guideline recommended statin therapy and cardiovascular disease outcomes: Data from a multisite healthcare network primary prevention cohort

BackgroundIn the US, women have similar cardiovascular death rates as men. However, less is known about sex differences in statin use for primary prevention and associated atherosclerotic cardiovascular disease (ASCVD) outcomes. MethodsStatin prescriptions using electronic health records were examined in patients without ASCVD (myocardial infarction (MI), revascularization or ischemic stroke) between 2013 and 2019. Guideline-directed statin intensity (GDSI) at index (at least moderate intensity, defined per pooled-cohort equation) and follow-up visits were compared between sexes across ASCVD risk groups, defined by the pooled-cohort equation. Cox regression hazard ratios were calculated for statin use and outcomes (myocardial infarction, stroke/transient ischemic attack (TIA), and all-cause mortality) stratified by sex. Interaction terms (statin and sex) were applied. ResultsAmong 282,298 patients, (mean age ∼ 50 years) 17.1 % women and 19.5 % men were prescribed any statin at index visit. Time to GDSI was similar between sexes, but the proportion of high-risk women on GDSI at follow-up were lower compared to high-risk men (2-years: 27.7 vs 32.0 %, and 5-years: 47.2 vs 55.2 %, p < 0.05). When compared to GDSI, no statin use was associated with higher risk of MI and ischemic stroke/TIA among both sexes. High-risk women on GDSI had a lower risk of mortality (HR=1.39 [1.22–1.59]) vs. men (HR=1.67 [1.50–1.86]) of similar risk (p value interaction=0.004). ConclusionIn a large contemporary healthcare system, there was underutilization of statins across both sexes in primary prevention. High-risk women were less likely to remain on GDSI compared to high-risk men. GDSI significantly improved the survival in both sexes regardless of ASCVD risk group. Future strategies to ensure continued use of GDSI, specifically among women, should be explored.

Abstract P510: Trends in Statin Therapy for Primary Prevention Among Older Veterans, 2003-2020

Introduction: The burden and risk of atherosclerotic cardiovascular disease (ASCVD) in US Veterans is higher than the general population, yet rates of use of medications for primary prevention, specifically statins, are not well described. Since the early 2000s, trial data have proven the efficacy of statins for primary prevention, further encouraged by updated guidelines (notably 2001, 2013, 2018). Therefore, we sought to examine the proportion of older veterans free of ASCVD and trends of statin use for primary prevention within this cohort from 2003 to 2020. Methods: Study participants comprised all US Veterans ≥65 years, free of ASCVD, and with at least one visit in the Veteran’s Health Administration (VHA) in the year prior. Statin users had at least two or more prescriptions of any statin in each one-year period studied. VA prescription data were linked to Medicare/Medicaid to ensure complete capture of statin use. Descriptive statistics and crude proportions were calculated by year of study entry. Results: From 2003-2020, there were 5.1 million Veterans aged 65 and older who received regular care in VHA. The overall proportion of veterans free of ASCVD in that period was 60% (N=3,159,705). Statin prescriptions for primary prevention have increased from 39% in 2003 to 52% in 2020, remaining steady after 2007. For example, in 2011, 51% were prescribed statins, mean age 73±7, 87% white, 98% male, 82% hypertension, 37% diabetes, 94% hyperlipidemia; while in 2017, 53% were prescribed statins (age 72± 7, 80% white, 97% male, 73% hypertension, 31% diabetes, 74% hyperlipidemia), received statin therapy for primary prevention (Figure). Conclusion: A substantial proportion of Veterans ≥65 years were at risk for ASCVD. While statin prescriptions for primary prevention have increased from 2003-2020, over the past 15 years, they have remained at around 50%. These findings indicate a focus on primary prevention among older Veterans is needed.

Identification of subgroups within a Japanese older adult population for whom statin therapy is effective in reducing mortality.

Use of statins for primary prevention can reduce all-cause mortality in Asian elderly populations, but their effect and the specific effective subgroups in the elderly Japanese population remain unclear. This study examined the relationship between statin therapy for primary prevention and mortality reduction in older Japanese adults, and investigated the effective subgroups. The cohort study was conducted using the Shizuoka Kokuho Database (SKDB). Data were compared between the statin-treated group and a non-statin-treated (control) group using the inverse probability of treatment weighting (IPTW) method. In the SKDB cohort aged ≥65 years, new statin use was associated with a decreased risk of all-cause mortality (hazard ratio, 0.40; 95% confidence interval [CI], 0.33-0.48) after IPTW adjustment. The risk difference for mortality at 5 years in the statin-treated group compared with that in the control group was 0.05 (95% CI, 0.04-0.06), and the number needed to treat was 21.20 (95% CI, 18.10-24.70). In conclusion, statin use for primary prevention in older adults may reduce the risk of all-cause mortality in the population without atherosclerotic disease. Furthermore, statin use for primary prevention is feasible in patients aged 75 to <85 years and in patients with comorbidities such as diabetes, or dementia.

Abstract 11599: High-Density Lipoprotein Cholesterol and Statin Use for Primary Prevention Among US Adults With Intermediate 10-year Predicted ASCVD Risk

Introduction: Although there is no strong evidence of a causal relationship between high-density lipoprotein cholesterol (HDL-C) with atherosclerotic cardiovascular disease (ASCVD), HDL-C is considered “good cholesterol” by many which may impact decision making around statin use. We determined if statin use for primary prevention differed by HDL-C levels among adults without ASCVD, diabetes mellitus (DM), or low-density lipoprotein cholesterol (LDL-C) &gt;190 mg/dL but an intermediate 10-year predicted ASCVD risk. Methods: National Health and Nutrition Examination Surveys (NHANES) participants who were non-pregnant, 40-75 years with a 10-year ASCVD risk 7.5-&lt;20% and fasting lipids, and without ASCVD, DM, LDL-C &gt; 190 mg/dL, or triglycerides ≥500 mg/dL from 2013-2020 were included. Multivariable Poisson regression with robust error variance estimated adjusted prevalence and prevalence ratios (PRs) and 95% confidence intervals (CIs) for statin use associated with HDL-C levels (low [&lt;40 mg/dL], normal [40-60 mg/dL], high [ &gt; 60 mg/dL]). Models were adjusted for age, race, ethnicity, sex, education, healthcare access within 12 months, routine location for health care, health insurance, LDL-C, and body mass index. Results: Among 999 included US adults (representing 23.7 million adults) with a 10-year predicted ASCVD risk 7.5-&lt;20%, the multivariable adjusted prevalence of statin use was 32.5%, 28.6%, and 24.4% among adults with low HDL-C, normal HDL-C, and high HDL-C, respectively. After adjustment, the PR for statin use among adults with low HDL-C was 1.14 (95% CI 1.01,1.18) and high HDL-C was 0.85 (95% 0.83,0.88) vs. adults with normal HDL-C (Figure 1). Discussion In the current analysis, adults with high HDL-C were less likely to be taking a statin, while adults with low HDL-C were more likely. HDL-C may influence the decision to use statin medication among adults with intermediate 10-year ASCVD risk despite evidence that HDL-C level is not causally related to ASCVD.

Age-based disparities in statin use for primary prevention in US adults: National Health and Nutrition Examination Surveys 2013–2020

Statin use among younger adults at high atherosclerotic cardiovascular disease (ASCVD) risk compared with older adults at the same risk is unclear. We determined prevalent statin use by 10-year ASCVD risk and age among US participants aged 40–75 eligible for risk-indicated primary prevention statins from the 2013–2020 National Health and Nutrition Examination Survey cycles. Among 3,503 participants, statin use by ASCVD risk (5-<7.5%, 7.5-<20%, and ≥20%) was 9.4%, 9.0%, and 12.2% among those age 40–54 compared to 22.0%, 23.9%, and 14.3% among adults 55–64 years and 39.3%, 33.6%, and 38.1% age 65–75 years. After adjusting for sociodemographic and healthcare access, the prevalence ratio (vs. 65–75 years) for statin use among adults with an ASCVD risk of 7.5-<20% age 40–54 years was 0.40 (95% confidence interval [CI] 0.39,0.41) and 0.87 (95% CI 0.87,0.88) for adults 55–64 years. Among high ASCVD-risk adults aged 40–75 years, primary prevention statin use was lower among adults <65 years despite similar ASCVD risk as older adults.

Efficacy, safety and clinical outcome associated with statin use for primary prevention in Korean patients with low-density lipoprotein cholesterol level ≥ 190 mg/dL: A retrospective cohort study.

Although the current guideline recommends the use of high-intensity statin to reduce the low-density lipoprotein cholesterol (LDL-C) level by 50% in patients with baseline value of ≥ 190 mg/dL, direct application of this recommendation to Asian populations is still questionable. This study was performed to investigate the statin response of LDL-C in Korean patients with LDL-C ≥ 190 mg/dL. A total of 1,075 Korean patients (age 60.7 ± 12.2 years, women 68%) with baseline LDL-C ≥ 190 mg/dL without cardiovascular disease was retrospectively reviewed. Lipid profiles at 6 months, side effects and clinical outcomes during the follow-up period after statin treatment were assessed according to statin intensity. Most of the patients (76.3%) were treated with moderate-intensity statins, 11.4% with high-intensity statins, and 12.3% with a statin + ezetimibe. The reductions in LDL-C percentage at 6 months were 48.0%, 56.0% and 53.3% in patients treated with moderate-intensity statins, high-intensity statins and statin + ezetimibe, respectively (P < 0.001). Side effects requiring dose reduction, medication switch or drug interruption were observed in 1.3%, 4.9% and 2.3% of patients treated with moderate-intensity statin, high-intensity statin and statin + ezetimibe, respectively (P = 0.024). During the median follow-duration of 815 days (interquartile range, 408-1,361 days), the incidences of cardiovascular events were not different among the 3 groups (log-rank P = 0.823). Compared to high-intensity statin, moderate-intensity statin was effective enough in reaching target goal of LDL-C without increase in cardiovascular risk and with fewer side effects in Korean patients with LDL-C ≥ 190 mg/dL.

Aspirin and statin use in primary prevention after coronary artery calcium score

Abstract Funding Acknowledgements Type of funding sources: None. Introduction A coronary artery calcium (CAC) score of more than 100 places the 10-year cardiovascular risk above 7.5%, justifying the initiation of pharmacological measures in primary prevention. Purpose The present study explores the level of implementation of a primary prevention strategy after CAC score in patients without obstructive coronary disease. Methods The study cohort included all patients from the health area of our city (Galicia, Spain) who underwent a coronary computed tomography (CT) scan between July 2021 and February 2022. Subjects with obstructive coronary disease (CADRADS 3 or higher), atrial fibrillation patients and inconclusive studies were excluded. The final population of the study consisted of 209 patients. The sample was classified according to Agatston Score into three groups: no calcification (CAC=0), non-significant (CAC 1-100), and significant calcification (CAC &amp;gt;101). Multinomial and binomial logistic regression were performed to identify the predictors associated with the prescription of statin and aspirin, respectively. Results 41 patients (19.62%) had significant calcification (CAC &amp;gt;101). Of those, 16 (39.02%) started aspirin and 21 (51.22%) started statin (Figure 1). The CAC score allowed to increase the percentage of patients who benefited from lipid-lowering treatment, from 31.70% to 82.92% (Figure 2). Significant differences were observed in the proportion of patients who initiated aspirin and statins according to the degree of coronary calcification (Chi2 18.76; p=0.000), (Chi2 48.42; p=0.000) respectively. After multivariate adjustment, a CAC score &amp;gt;100 (OR 5.88 (2.29-15.07; p=0.000) and the presence of vulnerable plaque (OR 6.78 (1.01-47.46; p=0.050) were the only predictos which led clinicians to start antiplatelet therapy. Neither age, nor SIS (segment involvement score) were associated. Regarding to lipid-lowering therapy, CAC score 1-100 (OR 5.87 (1.68-20.51; p=0.006) and CAC score &amp;gt;100 (OR 30.78 (5.08-186.47; p=0.000) were independently associated with statin prescription. Conclusions The use of coronary CT allows optimization of the therapeutic strategy in primary prevention, increasing the percentage of patients who may benefit from statins. In this setting, aspirin is little established in our cohort. Therefore, we should transmit to the clinician the possibility of starting antiplatelet therapy, individualizing the indication.

Prevalence of Statin Use for Primary Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and 10-Year Disease Risk in the US

The burden of atherosclerotic cardiovascular disease (ASCVD) in the US is higher among Black and Hispanic vs White adults. Inclusion of race in guidance for statin indication may lead to decreased disparities in statin use. To evaluate prevalence of primary prevention statin use by race and ethnicity according to 10-year ASCVD risk. This serial, cross-sectional analysis performed in May 2022 used data from the National Health and Nutrition Examination Survey, a nationally representative sample of health status in the US, from 2013 to March 2020 (limited cycle due to the COVID-19 pandemic), to evaluate statin use for primary prevention of ASCVD and to estimate 10-year ASCVD risk. Participants aged 40 to 75 years without ASCVD, diabetes, low-density lipoprotein cholesterol levels 190 mg/dL or greater, and with data on medication use were included. Self-identified race and ethnicity (Asian, Black, Hispanic, and White) and 10-year ASCVD risk category (5%-<7.5%, 7.5%-<20%, ≥20%). Prevalence of statin use, defined as identification of statin use on pill bottle review. A total of 3417 participants representing 39.4 million US adults after applying sampling weights (mean [SD] age, 61.8 [8.0] years; 1289 women [weighted percentage, 37.8%] and 2128 men [weighted percentage, 62.2%]; 329 Asian [weighted percentage, 4.2%], 1032 Black [weighted percentage, 12.7%], 786 Hispanic [weighted percentage, 10.1%], and 1270 White [weighted percentage, 73.0%]) were included. Compared with White participants, statin use was lower in Black and Hispanic participants and comparable among Asian participants in the overall cohort (Asian, 25.5%; Black, 20.0%; Hispanic, 15.4%; White, 27.9%) and within ASCVD risk strata. Within each race and ethnicity group, a graded increase in statin use was observed across increasing ASCVD risk strata. Statin use was low in the highest risk stratum overall with significantly lower rates of use among Black (23.8%; prevalence ratio [PR], 0.90; 95% CI, 0.82-0.98 vs White) and Hispanic participants (23.9%; PR, 0.90; 95% CI, 0.81-0.99 vs White). Among other factors, routine health care access and health insurance were significantly associated with higher statin use in Black, Hispanic, and White adults. Prevalence of statin use did not meaningfully change over time by race and ethnicity or by ASCVD risk stratum. In this study, statin use for primary prevention of ASCVD was low among all race and ethnicity groups regardless of ASCVD risk, with the lowest use occurring among Black and Hispanic adults. Improvements in access to care may promote equitable use of primary prevention statins in Black and Hispanic adults.

Statin Utilization Among Individuals Infected With Hepatitis C Virus: A Retrospective Cohort Study.

Introduction and Objectives Statin use for primary prevention of coronary artery disease (CAD) has historically been limited in patients with chronic liver disease due to concerns for increased adverse events with statin use in this population. We aimed to quantify the underutilization of statins among individuals with a history of HCV infection in a community health system to understand the clinical implications of statin underutilization in a diverse, generalizable population of patients infected with HCV. Materials and Methods We performed a single-center retrospective study of individualswith a history of HCV infection aged 40-75 years from 2019-2021. Statin eligibility was determined using the 2019 American College of Cardiology/American Heart Association (ACC/AHA) guidelines with the 2013 Pooled Cohort Equation used to determine atherosclerotic cardiovascular disease (ASCVD) risk. Baseline characteristics and adverse events of statin and non-statin users were compared, and factors associated with statin use were determined using multivariable logistical regression. Results Based on 2019 ACC/AHA guidelines, 752/1,077 (69.8%) subjects had an indication for a statin, 280/752 (37.2%) of which were treated with a statin. Cirrhosis was independently associated with statin underutilization. Diabetes, anti-hypertensive use, and Black race were all independently associated with statin use in subjects with an indication for therapy. Statin use was not associated with adverse events. Conclusions Statins were underutilized and well tolerated in the cohort of individuals with a history of HCV infection. This high-risk population would benefit from increased CAD screening and utilization of statins for the primary prevention of CAD.

Abstract 11668: Trends in Statin Use for Primary Prevention by Race/Ethnicity and ASCVD Risk in the US: 2013-2020

Introduction: The burden of ASCVD is higher among non-Hispanic Black (NHB) and Hispanic vs. non-Hispanic White (NHW) US adults, potentially due to differences in use of preventive medications such as statins. We evaluated patterns in statin use for primary prevention by self-identified race/ethnicity (NHB, NHW, and Hispanic) according to 10-year ASCVD risk using the Pooled Cohort Equations. Methods: This serial, cross-sectional analysis included NHANES participants from 2013-2020 age 40-75 years without ASCVD, diabetes, LDL ≥190 mg/dL, or missing data for estimation of 10-year ASCVD risk. Statin use was determined by interviewer pill bottle review. Poisson regression estimated adjusted prevalence ratios for statin use associated with race/ethnicity and ASCVD risk categories (5-&lt;7.5%, 7.5-&lt;20%, and ≥20%); all analyses incorporated NHANES survey weights. Results: A total of 3,088 participants representing 37.8 million US adults (mean age 62 y, 38% women, 13% NHB, 11% Hispanic, 76% NHW) were included. Overall, statin use was lower in NHB (20.0%) and Hispanic (15.4%) than NHW adults (27.9%). Within all ASCVD risk categories, the odds of statin use were significantly lower among NHB and Hispanic vs. NHW adults (Figure). Within each race/ethnicity group, the use of statins increased across increasing ASCVD risk strata, with a significantly greater utilization among those with ASCVD risk ≥20% (vs. ASCVD risk 5-&lt;7.5%) (Figure). Statin use was stable over time and within race/ethnicity and risk strata (p&gt;0.05 for all NHANES cycles). Conclusions: Overall statin use for primary prevention based on 10-year ASCVD risk was low in all race/ethnicity groups regardless of predicted ASCVD risk, though undertreatment was most severe in NHB and Hispanic adults. Improvements in equitable utilization of statins for primary prevention in Black and Hispanic adults are needed to address disparities in ASCVD.

Interactions Between Statins, Exercise, and Health: A Clinical Update

Interactions Between Statins, Exercise, and Health: A Clinical Update

Statin use in older people primary prevention on cardiovascular disease: an updated systematic review and meta-analysis.

Evidence on statin use for primary prevention of cardiovascular disease (CVD) in older people needs to be extended and updated, aiming to provide further guidance for clinical practice. PubMed, EMBASE, Cochrane Library and Web of Science were searched for eligible observational studies comparing statin use vs. no-statin use for primary prevention of CVD in older people (age 65 years). The primary outcomes were all-cause mortality, CVD mortality, coronary heart disease (CHD)/myocardial infraction (MI), stroke and total CV events. Risk estimates of each relevant outcome were synthesized as a hazard ratio (HR) with 95% confidence interval (95% CI) using in the random-effects model. Twelve eligible observational studies (n = 1,627,434) were enrolled. The pooled results suggested that statin use was associated with a significantly decreased risk of all-cause mortality (HR: 0.54, 95% CI: 0.46-0.63), CVD mortality (HR: 0.51, 95% CI: 0.39-0.65), CHD/MI (HR: 0.83, 95% CI: 0.69-1.00), stroke (HR: 0.79, 95% CI: 0.68-0.92) and total CV events (HR: 0.75, 95% CI: 0.66-0.85). The association in all-cause mortality still remained obvious at higher ages ( 70 years old, HR: 0.56, 95% CI: 0.44-0.71; 75 years old, HR: 0.70, 95% CI: 0.60-0.80; 85 years old, HR: 0.85, 95% CI: 0.74-0.97), 20% (HR: 0.47, 95% CI: 0.35-0.62) and 20% diabetic populations (HR: 0.50, 95% CI: 0.40-0.64), and 50% (HR: 0.68, 95% CI: 0.59-0.79) and 50% hypertensive populations (HR: 0.38, 95% CI: 0.16-0.88). Statin use was related to a 46%, 49%, 17%, 21% and 25% risk reduction on all-cause mortality, CVD mortality, CHD/MI, stroke and total CV events in older patients, respectively. The significant association was also addressed in older patients and 75 years old individuals for CVD primary prevention.

Moderate-intensity statin use for primary prevention for more than 5 years is associated with decreased all-cause mortality in 75 years and older

ObjectiveEvidence regarding the primary preventive effects of statin in the elderly is inadequate. This study aimed to determine the duration and intensity of statins beneficial in adults aged ≥75 years for primary prevention. MethodsThis is a retrospective longitudinal study, using the National Health Insurance Corporation-Senior Cohort data from 2002 to 2015. Exact block matching was used to select comparable subjects from statin users and non-users. ResultThe study subjects consisted of 685 pairs of statin non-users and users (total number of 1,370). During the follow-up (mean 8.7 years) period, the adjusted HR for mortality compared to non-user was 0.95 (p = 0.71) in low intensity statin users and 0.80 (p = 0.002) in the moderate intensity statin groups. The adjusted HR for MACE (Major Adverse Cardiovascular Events) compared to non-users was 1.10 (p = 0.39) in the low intensity statin group and 1.29 (p = 0.001) in the moderate intensity statin group. The risk of MACE disappeared five years after in moderate intensity statin users. Moderate intensity statin use was significantly associated with an increased risk of NODM (New Onset Diabetes Mellitus) (HR 1.50, p < 0.001) for up to three years, but the risk faded away after five years (HR 0.90, p = 0.52). ConclusionModerate intensity statins taken for five or more years for primary prevention would be associated with low risk of all-cause mortality in the 75+ years old. This result may support the evidence that initiation of statin for primary prevention in patients aged over 75 years is beneficial and tolerable.

Guidelines versus trial-evidence for statin use in primary prevention: The Copenhagen General Population Study

Background and aimsGuideline-recommended use of risk calculators to select for statin therapy in primary prevention has never been tested in a randomized controlled trial (RCT). We determined the extent to which guideline-based statin recommendations from the American College of Cardiology/American Heart Association (ACC/AHA), Canadian Cardiovascular Society(CCS), UK National Institute for Health and Care Excellence (NICE), and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) is supported by available evidence from RCTs. Methods79,171 individuals from the Copenhagen General Population Study who were free of ASCVD and statin use at baseline were included. RCT evidence supporting guideline-recommended statin allocation and the estimated number needed to treat (NNT) to prevent one ASCVD event were assessed. ResultsDuring 8.2 years of follow-up, 4031 ASCVD events occurred. Of individuals eligible for statin therapy with the ACC/AHA, CCS, NICE and ESC/EAS guidelines, 86%, 88%, 88% and 84% had direct RCT evidence of statin efficacy, respectively (guideline-positive&RCT-positive). This group represented 26–37% of all 79,171 individuals, while guideline-positive&RCT-negative individuals represented 5–7%, guideline-negative&RCT-positive individuals 28–39%, and guideline-negative&RCT-negative individuals represented 30–31%. The ASCVD events per 1000 person-years were 11.4–12.7 (guideline-positive&RCT-positive), 6.3–8.0 (guideline-positive&RCT-negative), 4.2–5.2 (guideline-negative&RCT-positive), and 2.3–2.5 (guideline-negative&RCT-negative), respectively, while the corresponding NNT to prevent one event in 10 years using high-intensity statin were 19–21, 30–32, 48–60, and 105–125, respectively. ConclusionsThe far majority of individuals eligible for guideline-recommended primary prevention with statins have direct RCT evidence supporting statin use. Allocating statins based on guideline-criteria is more efficient with lower NNT for preventing ASCVD events than allocating statin therapy based solely on RCT evidence.

Trends in statin utilisation in US adults with non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) has high morbidity and mortality related to cardiovascular disease (CVD), but statins have been historically underutilised in these patients due to concern for hepatotoxicity. To characterise trends in statin use among individuals with NAFLD and to determine predictors of statin utilisation in this population. Individuals with NAFLD were identified from 2005 to 2018 continuous National Health and Nutrition Examination Survey. Trends in statin use over time were assessed, and predictors of statin under-utilisation for primary prevention were identified. The roles of a known diagnosis of liver disease and disease severity were examined. We included 14113 individuals; 34.6% had NAFLD, of whom 5.4% reported a liver disease diagnosis. There was a significant increase in statin use for primary prevention between 2005 and 2018 (18.1%-25.0%; P=0.03), but guideline-indicated use for this purpose was low (54.5% between 2005 and 2012; 48.6% between 2013 and 2018). A known NAFLD diagnosis was a negative predictor of statin use during the earlier time period but not more recently. Utilisation did not decrease with increasing liver disease severity. In a nationally representative population with NAFLD, statin use for primary prevention has increased over time, but guideline-concordant use remains low. A known liver disease diagnosis was associated with lack of statin use in the earlier time period but not more recently, suggesting a changing perspective of underlying liver disease impacting statin utilisation. Further work to improve guideline-indicated statin use in this high-risk population is needed.

Statin use for primary prevention in patients with type 2 diabetes: Can it benefit all ages? – A nationwide propensity-matched cohort study

AimsThis study aims to investigate whether statin use is associated with a reduction in CVD and mortality in patients with type 2 diabetes without pre-existing CVD. MethodsA propensity score-matched cohort analysis using retrospective data was created. Statin users received at least a 90-day prescription, and never used statin before initiation of the study. Statin non-users never received statin throughout the study. Primary outcome was a composite of myocardial infarction (MI), stroke, and all-cause death, and secondary outcome was an individual event. ResultsThe propensity score matched cohort included 168,045 statin users and 168,045 non-users (mean age 57 years; median follow-up 5.0 years). Compared to statin non-users, the hazard ratio (HR) was 0.72 (95% confidence interval [CI] 0.70–0.73; P < 0.001) for composite outcomes, 0.80 (0.76–0.84; P < 0.001) for MI, 0.74 (0.71–0.76; P < 0.001) for stroke, and 0.68 (0.66–0.70; P < 0.001) for all-cause death in statin users. The risk reduction was most prominent in subjects aged 40–74 years, attenuated but significant in those aged ≥75 years, and not significant in those aged <40 years. ConclusionsStatin showed a protective effect against CVD and all-cause death in type 2 diabetes; this effect was reduced beyond the age of 75 years and disappeared in young patients aged <40 years.

Recommendations and Associated Levels of Evidence for Statin Use in Primary Prevention of Cardiovascular Disease: A Comparison at Population Level of the American Heart Association/American College of Cardiology/Multisociety, US Preventive Services Task Force, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society Clinical Practice Guidelines.

Despite using identical evidence to support practice guidelines for lipid-lowering treatment in primary prevention of cardiovascular disease (CVD), it is unclear to what extent the 2018 American Heart Association/American College of Cardiology/Multisociety, 2016 US Preventive Services Task Force (USPSTF), 2020 Department of Veterans Affairs/Department of Defense, 2021 Canadian Cardiovascular Society, and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines differ in grading and assigning levels of evidence and classes of recommendations (LOE/class) at a population level. We included 7262 participants, aged 45 to 75 years, without history of CVD from the prospective population-based Rotterdam Study. Per guideline, proportions of the population recommended statin therapy by LOE/class, sensitivity and specificity for CVD events, and numbers needed to treat at 10 years were calculated. Mean age was 61.1 (SD 6.9) years; 58.2% were women. American Heart Association/American College of Cardiology/Multisociety, USPSTF, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society strongly recommended statin initiation in respective 59.4%, 40.2%, 45.2%, 73.7%, and 42.1% of the eligible population based on high-quality evidence. Sensitivity for CVD events for treatment recommendations supported with strong LOE/class was 86.3% for American Heart Association/American College of Cardiology/Multisociety (IA or IB), 69.4% for USPSTF (USPSTF-B), 74.5% for Department of Veterans Affairs/Department of Defense (strong for), 93.3% for Canadian Cardiovascular Society (strong), and 66.6% for European Society of Cardiology/European Atherosclerosis Society (IA). Specificity was highest for the USPSTF at 45.3% and lowest for European Society of Cardiology/European Atherosclerosis Society at 10.0%. Estimated numbers needed to treat at 10 years for those with the strongest LOE/class were ranging from 20 to 26 for moderate-intensity and 12 to 16 for high-intensity statins. Sensitivity, specificity, and numbers needed to treat at 10 years for assigned LOE/class varied greatly among 5 CVD prevention guidelines. The level of variability seems to be driven by differences in how the evidence is graded and translated into LOE/class underlying the treatment recommendations by different professional societies. Efforts towards harmonizing evidence grading systems for clinical guidelines in primary prevention of CVD may reduce ambiguity and reinforce updated evidence-based recommendations.

Statin use for primary prevention of CVD associated with low risk of AEs

Statin use for primary prevention of CVD associated with low risk of AEs

Statin use for primary prevention of ASCVD in patients &gt;75 years of age

Evidence-Based Practice: June 11, 2021 - Volume - Issue - doi: 10.1097/EBP.0000000000001361