Trends in the Use of Nonstatin Lipid-Lowering Therapy Among Patients With Coronary Heart Disease: A Retrospective Cohort Study in the Medicare Population 2007 to 2011.
BACKGROUND
Nonstatin lipid-lowering therapy is adjunctive therapy for high-risk individuals on statins or monotherapy among those who cannot tolerate statins.


OBJECTIVE
This study determined time trends between 2007 and 2011 for statin and nonstatin lipid-lowering therapy (niacin, fibrates, bile acid sequestrants, and ezetimibe) use among Medicare beneficiaries with coronary heart disease (CHD) in light of emerging clinical trial evidence.


METHODS
We conducted a retrospective cohort study using the national 5% random sample of Medicare beneficiaries (n = 310,091). We created 20 cohorts of individuals with CHD, representing calendar quarters from 2007 through 2011, to assess trends in use of statins and nonstatin lipid-lowering medications.


RESULTS
Statin use increased from 53.1% to 58.8% between 2007 and 2011. Ezetimibe use peaked at 12.1% and declined to 4.6% by the end of 2011, declining among both patients on statins (18.4% to 6.2%) and not on statins (5.0% to 2.4%). Fibrate use increased from 4.2% to 5.0%, bile acid sequestrants did not change significantly, and niacin use increased from 1.5% to 2.4% and then declined in late 2011. Use of nonstatin lipid-lowering therapy was less common at older age, among African Americans, patients with heart failure, and patients with a higher Charlson comorbidity score. Nonstatin lipid-lowering therapy use was more common among men and patients with diabetes, those who had cardiologist visits, and among those taking statins.


CONCLUSIONS
Declining ezetimibe and niacin use but not fibrate therapy among Medicare beneficiaries with CHD coincides with negative clinical trial results for these agents.
University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: vbittner@uab.edu.
Vera
V
Bittner
University of Alabama at Birmingham, Birmingham, Alabama.
Luqin
L
Deng
Icahn School of Medicine at Mount Sinai, New York, New York.
Robert S
RS
Rosenson
Center for Observational Research, Amgen, Inc., Thousand Oaks, California.
Ben
B
Taylor
University of Alabama at Birmingham, Birmingham, Alabama.
Stephen P
SP
Glasser
University of Alabama at Birmingham, Birmingham, Alabama.
Shia T
ST
Kent
Icahn School of Medicine at Mount Sinai, New York, New York; Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada.
Michael E
ME
Farkouh
University of Alabama at Birmingham, Birmingham, Alabama.
Paul
P
Muntner
D000328:Adult; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D003327:Coronary Disease / Q000453:epidemiology*; D004363:Drug Utilization; D000069438:Ezetimibe / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000453:epidemiology*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D006278:Medicare; D009525:Niacin / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States
D000924:Anticholesteremic Agents; D000960:Hypolipidemic Agents; D009525:Niacin; D000069438:Ezetimibe
coronary heart disease; nonstatin lipid-lowering therapy; statin