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
Multicenter Study
. 2020 Jun;43(6):560-567.
doi: 10.1002/clc.23347. Epub 2020 Feb 27.

Trends in prevalence of guideline-based use of lipid-lowering therapy in a large health system

Abbey C Sidebottom  1 , Marc C Vacquier  1 , Joseph C Jensen  2 , Steven M Bradley  2   3 , Thomas Knickelbine  2   3 , Craig Strauss  2   3 , Michael D Miedema  2   3
Affiliations
Multicenter Study

Trends in prevalence of guideline-based use of lipid-lowering therapy in a large health system

Abbey C Sidebottom et al. Clin Cardiol. 2020 Jun.

Abstract

Background: The 2013 ACC/AHA (American College of Cardiology/American Heart Association) cholesterol guidelines provided an evidence-based rationale for the allocation of lipid-lowering therapy based on risk for atherosclerotic cardiovascular disease (ASCVD). Adoption of these guidelines was initially suboptimal but whether this has improved over time remains unclear.

Hypothesis: Prevalence of guideline-based statin therapy will increase over time.

Methods: Electronic health record data were used to create two cross-sectional data sets of patients (age 40-75) served in 2013 and 2017 by a large health system. Data sets included demographics, clinical risk factors, lipid values, diagnostic codes, and active medication orders during each period. Prevalence of indications for statin therapy according to the ACC/AHA guidelines and statin prescriptions were compared between each time period.

Results: In 2013, of the 219 376 adults, 57.7% of patients met statin eligibility criteria, of which 61.3% were prescribed any statin and 19.0% a high intensity statin. Among those eligible, statin use was highest in those with established ASCVD (83.9%) and lowest in those with elevated ASCVD risk >7.5% (39.3%). In 2017, of the 256 074 adults, 62.3% were statin eligible, of which 62.3% were prescribed a statin and 24.3% a high intensity statin. In 2017, 66.4% of statin eligible men were prescribed a statin compared to 57.4% of statin eligible women (P < 0.001). The use of ezetimibe (3.6% in 2013, 2.4% in 2017) and protein convertase subtilisin/kexin type 9 inhibitors (<0.1% and 0.1%) was infrequent.

Conclusion: In a large health system, guideline-based statin use has remained suboptimal. Improved strategies are needed to increase statin utilization in appropriate patients.

Keywords: cholesterol; guidelines; population health; statin.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Study sample selection process for 2013 and 2017 data sets. ASCVD, atherosclerotic cardiovascular disease
Figure 2
Figure 2
Statin use prevalence by ACC/AHA eligibility categories in 2013 and 2017, by sex. ACC/AHA, American College of Cardiology/American Heart Association; ASCVD, atherosclerotic cardiovascular disease; LDL‐C, low‐density lipoprotein cholesterol
See this image and copyright information in PMC

References

    1. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2014;63(25, pt B):2889‐2934. - PubMed
    1. National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143‐3421. - PubMed
    1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol. 2019;73(24):3168‐3209. - PubMed
    1. Pencina MJ, Navar‐Boggan AM, D'Agostino RB Sr, et al. Application of new cholesterol guidelines to a population‐based sample. N Engl J Med. 2014;370(15):1422‐1431. - PubMed
    1. Miedema MD, Sidebottom AC, Sillah A, Benson G, Knickelbine T, VanWormer JJ. Clinical implications of the American College of Cardiology/American Heart Association guidelines for the treatment of blood cholesterol for a rural community: data from the Heart of New Ulm Project. J Clin Lipidol. 2017;11(1):94‐101. - PubMed

Publication types

MeSH terms