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. 2022 Mar 20:10:100336.
doi: 10.1016/j.ajpc.2022.100336. eCollection 2022 Jun.

Lipid treatment status and goal attainment among patients with atherosclerotic cardiovascular disease in the United States: A 2019 update

Jing Gu  1 , Robert Sanchez  1 , Ankita Chauhan  2 , Sergio Fazio  1 , Nathan Wong  3
Affiliations

Lipid treatment status and goal attainment among patients with atherosclerotic cardiovascular disease in the United States: A 2019 update

Jing Gu et al. Am J Prev Cardiol. .

Abstract

Objective: To update the prevalence of atherosclerotic cardiovascular disease (ASCVD) in the United States (US) and re-evaluate lipid-lowering therapies (LLT) utilization and low-density lipoprotein cholesterol (LDL-C) goal attainment among ASCVD patients after proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have become available using data from 2019.

Methods: ASCVD patients with at least 1 valid LDL-C measurement from the 2019 Truven MarketScan Research Database were included and stratified into hierarchical cardiovascular risk groups. The number of patients in each group was extrapolated to approximate national figures based on national demographic and ASCVD prevalence numbers. Descriptive statistics on demographic and clinical characteristics, treatment status and LDL-C for each hierarchical category were reported.

Results: The overall prevalence of ASCVD in the US in 2019 was 24.0 million, approximately 10% of the total US population above 21 years old. We found heavy comorbidity burden among ASCVD patients and 31.2% were at very high risk for recurrent events. The majority of ASCVD patients were not at guideline-recommended LDL-C goal. Although there was a significant increase in the use of LLTs (especially of high-intensity statins) in 2019 compared to 2014, overall LLT utilization remained low, with only 3.8% of ASCVD patients on ezetimibe, less than 1% on PCSK9 inhibitors and over 40% on no LLTs. We also found higher utilization of LLTs among patients who were at goal of < 70 or < 55 mg/dL vs. those not at goal.

Conclusion: Despite an increase in high-intensity statins use since 2014, there was still an underutilization of LLTs in spite of evidence of their efficacy in LDL-C lowering and ability to reduce the risk of coronary heart disease. Increased awareness of guidelines by healthcare providers and urgency to treat ASCVD is needed in order to improve LLT utilization and help more patients reach the LDL-C goal.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jing Gu reports a relationship with Regeneron Pharmaceuticals Inc that includes: employment and equity or stocks. Robert Sanchez reports a relationship with Regeneron Pharmaceuticals Inc that includes: employment and equity or stocks. Sergio Fazio reports a relationship with Regeneron Pharmaceuticals Inc that includes: employment and equity or stocks. Ankita Chauhan reports a relationship with Axtria that includes: employment. Nathan Wong reports a relationship with Novartis that includes: consulting or advisory and funding grants. Nathan Wong reports a relationship with Gilead that includes: funding grants. Nathan Wong reports a relationship with Amgen Inc that includes: board membership. The sponsors were involved in the study design, and collection, analysis and interpretation of data, as well as data checking of information provided in the manuscript. All authors had unrestricted access to study data, were responsible for all content and editorial decisions, and received no honoraria related to the development of this publication.

Figures

Unlabelled image
Central illustration ACS: acute coronary syndrome; ASCVD: atherosclerotic cardiovascular disease; CHD: coronary heart disease; PAD: peripheral arterial disease; LLT: lipid lowering therapies
See this image and copyright information in PMC

References

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