Impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on the prescription of high-intensity statins in patients hospitalized for acute coronary syndrome or stroke.
BACKGROUND
The 2013 American College of Cardiology/American Heart Association cholesterol management guidelines represented a paradigm shift from the National Cholesterol Education Program Adult Treatment Panel III guidelines, replacing low-density lipoprotein cholesterol targets with a risk assessment model to guide statin therapy. Our objectives are to compare provider prescription of high-intensity statin therapy in patients hospitalized with acute coronary syndrome (ACS) or cerebrovascular accident (CVA) before and after the publication of the 2013 cholesterol guidelines, determine potential predictors of high-intensity statin utilization, and identify targets for improvement in cardiovascular risk reduction among these high-risk populations.


METHODS
A single-center retrospective cohort study of 695 patients discharged with a diagnosis of ACS or CVA in the 6months before (n=359) and after (n=336) the release of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines. Patient characteristics were compared using analysis of variance and χ2tests. Multivariable logistic regression models were used to assess clinical predictors of provider utilization of high-intensity statins.


RESULTS
After the 2013 cholesterol guidelines, the rate of prescribing high-intensity statins was greater for statin-naïve patients compared with those already on statin therapy (odds ratio [OR]0.51, P=.02). Prescription of high-intensity statins was higher for patients with ACS compared with CVA (OR 8.4, P<.001-pre-2013 guidelines; OR 4.5, P<.001-post-2013 guidelines). Prescription of high-intensity statins steadily improved over the study period, significantly among patients with CVA (P<.001).


CONCLUSIONS
Physicians were more likely to prescribe high-intensity statins in statin-naïve patients as compared with intensifying existing statin therapy, and their prescription pattern was lower after CVA vs ACS.
Division of Cardiology, Thomas Jefferson University, Sidney Kimmel Jefferson Medical College, Philadelphia, PA. Electronic address: Michael.Valentino@jefferson.edu.
Michael
M
Valentino
Department of Internal Medicine, Thomas Jefferson University, Sidney Kimmel Jefferson Medical College, Philadelphia, PA.
Jad
J
Al Danaf
Department of Internal Medicine, Thomas Jefferson University, Sidney Kimmel Jefferson Medical College, Philadelphia, PA.
Andrew
A
Panakos
Department of Internal Medicine, Thomas Jefferson University, Sidney Kimmel Jefferson Medical College, Philadelphia, PA.
Loheetha
L
Ragupathi
Division of Cardiology, Thomas Jefferson University, Sidney Kimmel Jefferson Medical College, Philadelphia, PA.
Danielle
D
Duffy
Division of Cardiology, Thomas Jefferson University, Sidney Kimmel Jefferson Medical College, Philadelphia, PA.
David
D
Whellan
D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy*; D000368:Aged; D000572:American Heart Association; D000789:Angina, Unstable / Q000097:blood / Q000188:drug therapy*; D000069059:Atorvastatin / Q000627:therapeutic use*; D002309:Cardiology; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D000068718:Rosuvastatin Calcium / Q000627:therapeutic use*; D012955:Societies, Medical; D020521:Stroke / Q000097:blood / Q000188:drug therapy*; D014481:United States
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin