title: Use of high-intensity statins for patients with atherosclerotic cardiovascular disease in the Veterans Affairs Health System: Practice impact of the new cholesterol guidelines.
abstract: BACKGROUND
  The November 2013 American College of Cardiology/American Heart Association cholesterol guidelines recommend the use of high-intensity statins for patients with atherosclerotic cardiovascular disease (ASCVD). We sought to determine how these guidelines are being adopted at the Veterans Affairs (VA) Health System and identify treatment gaps.
  
  
  METHODS
  We examined administrative data from the VA 12 months prior to the index dates of April 1, 2013, and after April 1, 2014, to identify patients ≤75 years of age with ≥2 codes for ASCVD. We identified those on high-intensity statin therapy (atorvastatin 40 mg or 80 mg, rosuvastatin 20 mg or 40 mg, and simvastatin 80 mg) during the 6 months after the index date.
  
  
  RESULTS
  The study sample included 331,927 and 326,759 eligible adults with ASCVD before and after the release of the new guidelines, respectively. Overall, high-intensity statin use increased from 28% to 35% after guideline release. High-intensity statin use was lowest in Hispanics and Native Americans, although all groups showed an increase over time. Among those on low- or moderate-intensity statin therapy, 15.6% were intensified to a high-intensity statin after guideline release. Groups less likely to undergo statin intensification were older adults (odds ratio=0.78 for each 10-year increase, 95% CI 0.76-0.81), women (odds ratio=0.86, 95% CI 0.75-0.99), and certain minority groups. Academic teaching hospitals and hospitals on the West Coast were more likely to intensify statins after release of the new guidelines.
  
  
  CONCLUSIONS
  High-intensity statin use increased in the VA following release of the American College of Cardiology/American Heart Association cholesterol treatment guidelines, although disparities persist for certain patient groups including older adults, women, and certain minority groups.
authors.affiliation: Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA.
authors.forename: Fatima
authors.initials: F
authors.lastname: Rodriguez
authors.affiliation: Veterans Affairs Health System, Palo Alto, CA.
authors.forename: Shoutzu
authors.initials: S
authors.lastname: Lin
authors.affiliation: Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.affiliation: Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Knowles
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, CA; Veterans Affairs Health System, Palo Alto, CA. Electronic address: heiden@stanford.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
mesh_terms: D000368:Aged; D000572:American Heart Association; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000069059:Atorvastatin / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D054539:Medication Therapy Management / Q000458:organization & administration / Q000592:standards; D008875:Middle Aged; D000068718:Rosuvastatin Calcium / Q000627:therapeutic use*; D019821:Simvastatin / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology; D058014:Veterans Health
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin; D019821:Simvastatin