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. 2025 Jul 23:23:101067.
doi: 10.1016/j.ajpc.2025.101067. eCollection 2025 Sep.

Real-world prescribing in accordance to ACC/AHA guidelines for lipid-lowering therapy in high-risk primary and secondary prevention of ASCVD: Real-World Prescribing for Lipid-Lowering Therapy

Jonathan Arnold  1 , Deeksha Acharya  2 , Hetal Boricha  2 , Himal Chapagain  3 , Aleesha Kainat  2 , Allison Bradley  4 , Jong-Hyeon Jeong  5 , Kevin A Townsend  6 , Mohammad B Ateya  6 , David A DeMicco  6 , YousefAlish  7 , Michael J Becich  4 , Cynthia H Chuang  8 , Soledad A Fernandez  7 , Daniel E Ford  9 , Wenke Hwang  8 , H Lester Kirchner  10 , Richard Morgan  4 , Anuradha Paranjape  11 , Neena A Thomas  12 , David A Williams  13 , RozelleHegeman-Dingle  6 , Euan McLeod  6 , Phillip A Saccone  6 , Kathleen M McTigue  1
Affiliations

Real-world prescribing in accordance to ACC/AHA guidelines for lipid-lowering therapy in high-risk primary and secondary prevention of ASCVD: Real-World Prescribing for Lipid-Lowering Therapy

Jonathan Arnold et al. Am J Prev Cardiol. .

Abstract

Objective: The value of lipid lowering therapy (LLT) for prevention of atherosclerotic cardiovascular disease (ASCVD) is well understood. American College of Cardiology and American Heart Association guidelines recommend statin therapy for secondary and high-risk primary ASCVD prevention. Prior studies have identified incomplete uptake of these guidelines in specific practice settings or patient populations. Here we characterized real-world LLT prescribing relative to guideline recommendations across seven US health systems.

Methods: Cross-sectional analyses of records from the PaTH Clinical Research Network focused on three cohorts: adults with ASCVD (ASCVD cohort), those aged 40-75 without ASCVD but with diabetes mellitus (DM cohort), and those not in either prior category but with a history of low-density lipoprotein (LDL-C) >190 mg/dl (LDL-C cohort). We describe patient characteristics, patterns of care, lipid values, and documented LLT within each cohort and variation between health systems.

Results: We identified 240,625 patients within the ASCVD cohort (LDL-C mean 86, SD 40 mg/dL), 113,662 patients in the DM cohort (LDL-C mean 93, SD 37 mg/dL), and 11,276 patients in the LDL-C cohort (LDL-C mean 208, SD 33 mg/dL. Among ASCVD cohort members, 37 % achieved the target LDL-C < 70 mg/dL, 62 % were prescribed LLT, 34 % were prescribed guideline-concordant high-intensity statin therapy. In the DM cohort, 27 % had LDL-C < 70 mg/dl, 54 % were on statin therapy, 19 % on high-intensity statin therapy. In the LDL-C cohort, 97 % had an LDL-C > 160 mg/dl, 44 % were on statin therapy and 16 % on high-intensity statin therapy. There was significant variability in documented LLT between health systems.

Conclusions: In this real-world descriptive study across multiple health systems for patients meeting criteria for secondary or high-risk primary ASCVD prevention, most patients had no documented high-intensity statin prescriptions and did not meet LDL-C targets. There was significant variability in care across health systems. Opportunities remain for improvement in guideline adherence to reduce ASCVD risk.

Keywords: Cardiovascular diseases; Drug prescriptions; Drug utilization; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; LDL Cholesterol; Lipid lowering therapy; Practice patterns; Primary prevention; Real-world evidence; Secondary prevention; Statins.

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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: Jonathan Arnold reports financial support was provided by Pfizer Inc. H. Lester Kirchner reports financial support was provided by Pfizer Inc. Kathleen McTigue reports financial support was provided by Pfizer Inc. Kathleen McTigue reports financial support was provided by Amgen Inc. Kathleen McTigue reports financial support was provided by Eli Lilly and Company. Kathleen McTigue reports was provided by Janssen Pharmaceuticals Inc. Michael J. Becich reports a relationship with PredxBio that includes: board membership and equity or stocks. Mohammad Ateya reports a relationship with Pfizer Inc that includes: employment and equity or stocks. David A DeMicco reports a relationship with Pfizer Inc that includes: employment and equity or stocks. Rozelle Hegeman-Dingle reports a relationship with Pfizer Inc that includes: employment and equity or stocks. Euan McLeod reports a relationship with Pfizer Inc that includes: employment and equity or stocks. Phillip A. Saccone reports a relationship with Pfizer Inc that includes: employment and equity or stocks. Kevin A. Townsend reports a relationship with Pfizer Inc that includes: employment. Michael J. Becich has patent SCORGI licensed to PredxBio. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
Flow diagram of query inclusion criteria and identification of clinical cohorts for individuals meeting AHA/ACC recommendations of lipid-lowering therapy for secondary or high-risk primary ASCVD prevention.
Fig 2
Fig. 2
Rates of lipid lowering therapy (LLT) for primary and secondary prevention overall (labeled All) and by individual health system (labeled A-G).
Central Illustration
Central Illustration
A multi-site cross-sectional study of real-world lipid-lowering therapy prescribing and patient characteristics in high-risk primary and secondary prevention of ASCVD.
See this image and copyright information in PMC

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