High-Intensity Statin Use Among Patients With Atherosclerosis in the U.S

Abstract

Background: Preventive therapy among patients with established atherosclerotic cardiovascular disease (ASCVD) is generally underused. Whether new guideline recommendations and a focus on implementation have improved the use of high-intensity statins is unknown.

Objectives: This study sought to evaluate the patterns and predictors of statin use among patients with ASCVD.

Methods: In this retrospective cohort study, pharmacy and medical claims data from a commercial health plan were queried for patients with established ASCVD between January 31, 2018, and January 31, 2019. Statin use on an index date of January 31, 2019, was evaluated, as was 12-month adherence and discontinuation. Multivariable logistic regression was used to determine independent associations with statin use of varying intensities.

Results: Of the 601,934 patients with established ASCVD, 41.7% were female, and the mean age was 67.5 ± 13.3 years. Overall, 22.5% of the cohort were on a high-intensity statin, 27.6% were on a low- or moderate-intensity statin, and 49.9% were not on any statin. In multivariable analysis, younger patients, female patients, and those with higher Charlson comorbidity score were less likely to be prescribed any statin. Among statin users, female patients, older patients, and those with peripheral artery disease were less likely to be on a high-intensity formulation, whereas a cardiology encounter in the prior year increased the odds. The majority of high-intensity stain users achieved high levels of adherence.

Conclusions: Substantial underuse of statins persists in a large, insured, and contemporary cohort of patients with ASCVD from the United States. In particular, concerning gaps in appropriate statin use remain among younger patients, women, and those with noncoronary ASCVD.

Keywords: atherosclerosis; predictors; prevention; secondary prevention; statins.

Figure 1.. CONSORT Diagram.

Progressive identification of eligible participants based on inclusion criteria to generate final analytic cohort of 601 934.

Figure 2.. Statin use among key subgroups.

Patients presented by baseline statin use (high-intensity = green; other statin = yellow, and no statin = orange) within key subgroups of age, gender and ASCVD phenotype. CAD - coronary artery disease; CeVD – cerebrovascular disease; PAD – peripheral artery disease;

Figure 3.. Sankey diagram illustrating the dynamics of statin use in follow-up.

The proportion of patients receiving high-intensity statins are shaded green, those receiving non-high-intensity statins in yellow and no statin in orange. The black numbers represent the shaded proportion as a percentage of the overall population. The vertical lines represent 3-month intervals.

Central illustration.. Statin use in 601934 ASCVD patients on 31st January 2019.

Proportion on high-intensity statin vs. other statin vs. no statin. Odds of high (vs. other) intensity statin use. Proportion of days covered among users of high-intensity statins.