title: Implications of the 2013 ACC/AHA cholesterol guidelines for adults in contemporary cardiovascular practice: insights from the NCDR PINNACLE registry.
abstract: BACKGROUND
  In a significant update, the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines recommend fixed-dose statin therapy for those at risk and do not recommend nonstatin therapies or treatment to target low-density lipoprotein cholesterol (LDL-C) levels, limiting the need for repeated LDL-C testing.
  
  
  OBJECTIVE
  The goal of this study was to examine the impact of the 2013 ACC/AHA cholesterol guidelines on current U.S. cardiovascular practice.
  
  
  METHODS
  Using the NCDR PINNACLE (National Cardiovascular Data Registry Practice Innovation and Clinical Excellence) registry data from 2008 to 2012, we assessed current practice patterns as a function of the 2013 cholesterol guidelines. Lipid-lowering therapies and LDL-C testing patterns by patient risk group (atherosclerotic cardiovascular disease [ASCVD], diabetes, LDL-C ≥190 mg/dl, or an estimated 10-year ASCVD risk ≥7.5%) were described.
  
  
  RESULTS
  Among a cohort of 1,174,545 patients, 1,129,205 (96.1%) were statin-eligible (91.2% ASCVD, 6.6% diabetes, 0.3% off-treatment LDL-C ≥190 mg/dl, 1.9% estimated 10-year ASCVD risk ≥7.5%). There were 377,311 patients (32.4%) not receiving statin therapy and 259,143 (22.6%) receiving nonstatin therapies. During the study period, 20.8% of patients had 2 or more LDL-C assessments, and 7.0% had more than 4.
  
  
  CONCLUSIONS
  In U.S. cardiovascular practices, 32.4% of statin-eligible patients, as defined by the 2013 ACC/AHA cholesterol guidelines, were not currently receiving statins. In addition, 22.6% were receiving nonstatin lipid-lowering therapies and 20.8% had repeated LDL-C testing. Achieving concordance with the new cholesterol guidelines in patients treated in U.S. cardiovascular practices would result in significant increases in statin use, as well as significant reductions in nonstatin therapies and laboratory testing.
authors.affiliation: Cardiology Section, VA Eastern Colorado Health Care System, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado. Electronic address: thomas.maddox@va.gov.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: George Washington University, Washington, DC.
authors.forename: William B
authors.initials: WB
authors.lastname: Borden
authors.affiliation: Mid-America Heart Institute, Kansas City, Missouri.
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.affiliation: Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: American College of Cardiology, Washington, DC.
authors.forename: William J
authors.initials: WJ
authors.lastname: Oetgen
authors.affiliation: National Quality Forum, Washington, DC.
authors.forename: J Brendan
authors.initials: JB
authors.lastname: Mullen
authors.affiliation: Mid-America Heart Institute, Kansas City, Missouri.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.affiliation: Lancaster General Health, Lancaster, Pennsylvania.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Casale
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.affiliation: Cardiology Section, VA Eastern Colorado Health Care System, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Fredrick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: George Washington University, Washington, DC.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Farmer
authors.affiliation: Cardiology Section, VA Eastern Colorado Health Care System, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
mesh_terms: D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012042:Registries; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: cardiovascular diseases; cholesterol; cohort studies; hydroxymethylglutaryl-coA reductase inhibitors; primary prevention; secondary prevention