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. 2021 Jun;44(6):863-870.
doi: 10.1002/clc.23625. Epub 2021 May 18.

Patient perceptions and use of non-statin lipid lowering therapy among patients with or at risk for atherosclerotic cardiovascular disease: Insights from the PALM registry

Angela Lowenstern  1   2 , Shuang Li  1 , Ann Marie Navar  1   2 , Salim S Virani  3 , Veronique L Roger  4 , Jennifer G Robinson  5 , Anne C Goldberg  6 , Wendy Kampman  7 , Eric D Peterson  1   2 , Tracy Y Wang  1   2
Affiliations

Patient perceptions and use of non-statin lipid lowering therapy among patients with or at risk for atherosclerotic cardiovascular disease: Insights from the PALM registry

Angela Lowenstern et al. Clin Cardiol. 2021 Jun.

Abstract

Background: Non-statin lipid lowering therapies (LLTs) provide additional treatment options for patients. Use patterns and patient perceptions of non-statin LLT remain incompletely described.

Hypothesis: The guideline-recommended statin intensity remains underutilized in patients treated with and without non-statin LLT.

Methods: The PALM Registry collected LLT information on patients with or at risk of ASCVD treated at 125 US clinics in 2015. We compared patient perceptions, lipid levels and statin use among patients treated with and without non-statin LLT.

Results: Among 7720 patients, 1930 (25.0%) were treated with a non-statin LLT (1249 fish oil, 417 fibrates, 329 ezetimibe, 196 niacin). Concurrent statin treatment occurred in 73.7%, of which 45.4% were dosed under the guideline-recommended intensity. Compared with patients on statin alone, patients receiving both a statin and non-statin LLT (n = 1423) were more likely to be male, white race and to perceive themselves as higher risk of ASCVD compared with their peers (38.5% vs. 34.9%, p = .047). Only 27.4% of patients treated with non-statin LLT alone perceived themselves at higher risk. Most (75.7%) patients treated with a non-statin LLT alone reported never being treated with a statin, despite ASCVD in 30.8% of these patients. Among those previously treated with a statin, 59.3% reported being willing to try a statin again.

Conclusions: Non-statin LLT is used in one in four patients with or at risk for ASCVD; its use is frequently in place of statin therapy or in the absence of guideline-recommended statin intensity. More work is needed to establish statins as first line therapy.

Keywords: lipid-lowering therapy; primary prevention; secondary prevention; statin.

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Conflict of interest statement

Angela Lowenstern: Dr. Lowenstern reports funding through NIH T‐32 training grant #5 T32 HL069749‐14.

Shuang Li: Ms. Li reports no relevant disclosures.

Ann Marie Navar: Dr. Navar is supported by the NIH, NHLBI K01HL133416–01 and reports research support from Amgen, Sanofi, and Regeneron; consulting fees from Amgen and Sanofi.

Salim S. Virani: Dr. Virani reports research support from ADA/AHA/ VA; honorarium from ACC as the Associate Editor for Innovations, ACC.org.

Veronique L. Roger: Dr. Roger reports no relevant disclosures.

Jennifer G. Robinson: Dr. Robinson reports research support from Amarin, Amgen, Astra‐Zeneca, Eli Lilly, Esai, Glaxo‐Smith Kline, Merck, Pfizer, Regeneron/Sanofi, Takeda; consultant for Amgen, Eli Lilly, Merck, Pfizer, Regeneron/Sanofi.

Anne C. Goldberg: Dr. Goldberg reports research support from Amarin, Amgen, Pfizer, Merck, Regeneron/Sanofi, IONIS, Genzyme/Isis, and Regeneron, Madrigal, and Arisaph; consulting for Optum Rx, Regeneron/Sanofi, and Esperion; honorarium for editorial work Merck Manual.

Wendy Kampman: Dr. Kampman reports employment with Regeneron Pharmaceuticals, Inc.

Eric D. Peterson: Dr. Peterson reports research support from Eli Lilly, Janssen, Merck; Consulting from AstraZeneca, Bayer, Boehringer Ingelheim, Genentech, Janssen, Merck, and Sanofi Aventis.

Tracy Y. Wang: Dr. Wang reports research support from AstraZeneca, Daiichi Sankyo, Eli Lilly, Gilead, Glaxo SmithKline, Regeneron, Sanofi; consultant/advisory/education from Bristol Myers Squibb, Astra Zeneca, Eli Lilly, Premier, Inc.

Figures

FIGURE 1
FIGURE 1
Blood lipid levels among patients treated with a statin or combination statin and non‐statin lipid lowering therapy
FIGURE 2
FIGURE 2
Blood lipid levels among patients treated with non‐statin lipid lowering therapy versus no lipid lowering therapy
See this image and copyright information in PMC

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