title: Patterns and predictors of lipid-lowering therapy in patients with atherosclerotic cardiovascular disease and/or diabetes mellitus in 2014: Insights from a large US managed-care population.
abstract: BACKGROUND
  Lowering low-density lipoprotein cholesterol with statins reduces risk of cardiovascular events. We examined patterns and predictors of filled prescriptions for lipid-lowering therapy (LLT) in subgroups of patients with atherosclerotic cardiovascular disease (ASCVD) and/or diabetes mellitus (DM).
  
  
  OBJECTIVE
  Statin treatment remains underutilized across subgroups of high CV risk patients.
  
  
  METHODS
  Patients in the Optum Research Database with these criteria were included: age ≥20 years, 2 years continuous enrollment, and ASCVD and/or DM. Patients were hierarchically classified by the presence of recent acute coronary syndrome, other coronary heart disease, ischemic stroke, peripheral arterial disease (PAD), or only DM. Predictors of filled LLT regimens were examined using multinomial logistic regression.
  
  
  RESULTS
  A total of 1 055 932 individuals met all inclusion criteria. Evidence by point-in-time analysis of filled (not only written) statin prescriptions was 45% for the overall cohort. By subgroups, this was 62%, 52%, 43%, 36%, and 40% for recent acute coronary syndrome, other coronary heart disease, ischemic stroke, PAD, and only DM, respectively. Predictors of higher rates of any statin regimen included age 50 to 69 years, male sex, absence of comorbidities, and filled prescriptions of other standard-of-care therapies.
  
  
  CONCLUSIONS
  In 2014, only 49% of patients with ASCVD and 40% with only DM had evidence for a filled statin prescription. Those with indications of ischemic stroke, PAD, and DM were less likely to receive statins than those with coronary conditions. Other characteristics such as advanced age, female sex, and noncardiac conditions predicted less statin utilization, thereby representing good targets for quality improvement.
authors.affiliation: Division of Cardiovascular Health and Disease, University of Cincinnati Medical Center, Cincinnati, Ohio.
authors.forename: Dylan L
authors.initials: DL
authors.lastname: Steen
authors.affiliation: Global Health Economics and Outcomes Research, Sanofi, Bridgewater, New Jersey.
authors.forename: Irfan
authors.initials: I
authors.lastname: Khan
authors.affiliation: Health Economics and Outcomes Research, Optum, Eden Prairie, Minnesota.
authors.forename: Laura
authors.initials: L
authors.lastname: Becker
authors.affiliation: Formerly of: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: JoAnne M
authors.initials: JM
authors.lastname: Foody
authors.affiliation: Global Health Economics and Outcomes Research, Sanofi, Bridgewater, New Jersey.
authors.forename: Katherine
authors.initials: K
authors.lastname: Gorcyca
authors.affiliation: Health Economics and Outcomes Research, Regeneron Pharmaceuticals Inc., Tarrytown, New York.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sanchez
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Giugliano
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood* / Q000187:drug effects; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: coronary disease; diabetes mellitus; lipid-lowering therapy; peripheral vascular disease; stroke