title: Frequency of high-risk patients not receiving high-potency statin (from a large managed care database).
abstract: We examined trends in low-density lipoprotein cholesterol (LDL-C) goal attainment in high-risk patients and use of high-potency statins (HPS) in a large, managed-care database from 2004 to 2012. The 2013 American Heart Association/American College of Cardiology prevention guidelines recommend that subjects with atherosclerotic cardiovascular disease (ASCVD) should be prescribed HPS therapy, irrespective of LDL-C levels. Previous guidelines recommend an LDL-C target <70 mg/dl. Patients diagnosed with ASCVD based on International Classification of Diseases, Ninth Revision codes with ≥1 LDL-C test from January 2004 to December 2012 were identified in the Optum Insight database. Patients were identified as treated if they received lipid-lowering therapy (LLT) within 90 days of the LDL-C measurement and untreated if they did not receive LLT treatment. LLT treated patients were stratified into HPS users or non-HPS LLT users. There were 45,101 eligible patients in 2004 and 40,846 in 2012. The proportion of high-risk patients who were treated with LLT increased from 61.4% (2004) to 70.5% (2008) then remained relatively constant until 2012 (67.9%). Mean LDL-C values in treated patients decreased from 103.7 ± 32.1 (2004) to 90.8 ± 31.4 mg/dl (2012). The proportion of patients treated with HPS increased from 13% in 2004 to 26% in 2012. Although the proportion of treated high-risk patients who achieve LDL-C <70 mg/dl levels has increased sharply from 2004, approximately 3 of 4 patients still did not meet this target. Only 1/4 of ASCVD patients are on HPS. In conclusion, our findings highlight the need for renewed efforts to support guideline-based LDL-C treatment for high-risk patients.
authors.affiliation: Division of Cardiovascular Medicine, Stanford Hospital and Clinics, Stanford, California.
authors.forename: Fatima
authors.initials: F
authors.lastname: Rodriguez
authors.affiliation: Center for Observational and Real World Evidence, Merck Sharpe and Dohme Inc., Whitehouse Station, New Jersey.
authors.forename: Temitope
authors.initials: T
authors.lastname: Olufade
authors.affiliation: Center for Observational and Real World Evidence, Merck Sharpe and Dohme Inc., Whitehouse Station, New Jersey.
authors.forename: Kim
authors.initials: K
authors.lastname: Heithoff
authors.affiliation: DataMed Solutions LLC, New York, New York.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Friedman
authors.affiliation: DataMed Solutions LLC, New York, New York.
authors.forename: Prakash
authors.initials: P
authors.lastname: Navaratnam
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: jfoody@partners.org.
authors.forename: JoAnne M
authors.initials: JM
authors.lastname: Foody
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology*; D015994:Incidence; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors