title: Statin underuse and low prevalence of LDL-C control among U.S. adults at high risk of coronary heart disease.
abstract: BACKGROUND
  Statins reduce the risk of coronary heart disease (CHD) in individuals with a history of CHD or risk equivalents. A 10-year CHD risk >20% is considered a risk equivalent but is frequently not detected. Statin use and low-density lipoprotein cholesterol (LDL-C) control were examined among participants with CHD or risk equivalents in the nationwide Reasons for Geographic and Racial Differences in Stroke study (n = 8812).
  
  
  METHODS
  Participants were categorized into 4 mutually exclusive groups: (1) history of CHD (n = 4025); (2) no history of CHD but with a history of stroke and/or abdominal aortic aneurysm (AAA) (n = 946); (3) no history of CHD or stroke/AAA but with diabetes mellitus (n = 3134); or (4) no history of the conditions in (1) through (3) but with 10-year Framingham CHD risk score (FRS) >20% calculated using the third Adult Treatment Panel point scoring system (n = 707).
  
  
  RESULTS
  Statins were used by 58.4% of those in the CHD group and 41.7%, 40.4% and 20.1% of those in the stroke/AAA, diabetes mellitus and FRS >20% groups, respectively. Among those taking statins, 65.1% had LDL-C <100 mg/dL, with no difference between the CHD, stroke/AAA, or diabetes mellitus groups. However, compared with those in the CHD group, LDL-C <100 mg/dL was less common among participants in the FRS >20% group (multivariable adjusted prevalence ratio: 0.72; 95% confidence interval: 0.62-0.85). Results were similar using the 2013 American College of Cardiology/American Heart Association cholesterol treatment guideline.
  
  
  CONCLUSIONS
  These data suggest that many people with high CHD risk, especially those with an FRS >20%, do not receive guideline-concordant lipid-lowering therapy and do not achieve an LDL-C <100 mg/dL.
authors.affiliation: Department of Epidemiology (CMG, EBL, HY, PM), University of Alabama at Birmingham, Birmingham, Alabama; Division of Preventive Medicine (CMG, MMS, SG), University of Alabama at Birmingham, Birmingham, Alabama; Department of Medicine - Section of Preventive Medicine and Epidemiology (DMM), Boston University, Boston, Massachusetts; Center for Observational Research (JMW), Amgen, Inc., Thousand Oaks, California; Mount Sinai Heart (RR, MK), Icahn School of Medicine at Mount Sinai, New York City, New York.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Gamboa
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Emily B
authors.initials: EB
authors.lastname: Levitan
authors.forename: Devin M
authors.initials: DM
authors.lastname: Mann
authors.forename: Huifeng
authors.initials: H
authors.lastname: Yun
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Glasser
authors.forename: J Michael
authors.initials: JM
authors.lastname: Woolley
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenson
authors.forename: Michael
authors.initials: M
authors.lastname: Farkouh
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000517:prevention & control*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008962:Models, Theoretical; D015995:Prevalence; D012307:Risk Factors; D014481:United States
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors