Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2017 Mar;40(3):155-162.
doi: 10.1002/clc.22641. Epub 2016 Dec 27.

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

Dylan L Steen  1 , Irfan Khan  2 , Laura Becker  3 , JoAnne M Foody  4 , Katherine Gorcyca  2 , Robert J Sanchez  5 , Robert P Giugliano  6
Affiliations
Observational Study

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

Dylan L Steen et al. Clin Cardiol. 2017 Mar.

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).

Hypothesis: 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.

Keywords: coronary disease; diabetes mellitus; lipid-lowering therapy; peripheral vascular disease; stroke.

PubMed Disclaimer

Conflict of interest statement

D.L. Steen receives modest consultant fees from Sanofi and Regeneron. I. Khan and K. Gorcyca are employees of Sanofi. L. Becker is an employee of Optum. J.M. Foody was a consultant to Sanofi, Pfizer, Merck, and AstraZeneca at the time of initiating this analysis; she is now an employee of Merck and Co. R. Sanchez is an employee of Regeneron Pharmaceuticals, Inc. R.P. Giugliano discloses that his institution (Brigham and Women's Hospital) has received significant research‐grant support from Amgen and Merck to conduct clinical trials of lipid‐lowering therapies and that he has received modest honoraria for CME lectures and/or consulting from Amgen, Merck, Regeneron, and Sanofi related to lipid‐lowering therapies. The authors declare no other potential conflicts of interest.

Figures

Figure 1
Figure 1
Determination of treatment status as of the index date. Blue bars representing medication supply via (A) filled Rx on the index date or (B) filled Rx within 30 days prior to the index date define the patient as being treated as of the index date. The red bar, representing medication supply via (C) filled Rx >30 days prior to the index date, defines the patient as not being treated as of the index date. Abbreviations: Rx, prescription.
Figure 2
Figure 2
Flowchart of the cohort selection for the study. *High‐CV‐risk conditions: ACS, other CHD, ischemic stroke, PAD, DM. Abbreviations: ACS, acute coronary syndrome; CHD, coronary heart disease; CV, cardiovascular; DM, diabetes mellitus; PAD, peripheral arterial disease.
See this image and copyright information in PMC

References

    1. Baigent C, Blackwell L, Emberson J, et al; Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta‐analysis of data from 170 000 participants in 26 randomised trials. Lancet. 2010;376:1670–1681. - PMC - PubMed
    1. Mihaylova B, Emberson J, Blackwell L, et al; Cholesterol Treatment Trialists’ (CTT) Collaboration. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta‐analysis of individual data from 27 randomised trials. Lancet. 2012;380:581–590. - PMC - PubMed
    1. Kashani A, Phillips CO, Foody JM, et al. Risks associated with statin therapy: a systematic overview of randomized clinical trials. Circulation. 2006;114:2788–2797. - PubMed
    1. Rosenson RS, Kent ST, Brown TM, et al. Underutilization of high‐intensity statin therapy after hospitalization for coronary heart disease. J Am Coll Cardiol. 2015;65:270–277. - PubMed
    1. Wong ND, Young D, Zhao Y, et al. Prevalence of the American College of Cardiology/American Heart Association statin eligibility groups, statin use, and low‐density lipoprotein cholesterol control in US adults using the National Health and Nutrition Examination Survey 2011–2012. J Clin Lipidol. 2016;10:1109–1118. - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources