Nearly half of patients with atherosclerotic cardiovascular disease (ASCVD) were not being treated with a statin and a quarter were not on a high-intensity statin in a large cohort of insured patients, according to a study published May 2 in the Journal of the American College of Cardiology. 

Adam J. Nelson, MBBS, PhD, et al., conducted a retrospective cohort study of pharmacy and medical claims data from a commercial health plan to examine patterns and predictors of high-intensity statin use among patients with ASCVD included in the database between Jan. 31, 2018 and Jan. 31, 2019. A total of 601,934 patients were included in the study; their mean age was 67.5 years and 41.7% were women. The majority had coronary artery disease (69.2%), 19.5% had cerebrovascular disease, 35.2% had peripheral artery disease (PAD) and 19.8% had polyvascular disease.

Results showed that 22.5% of study patients met the primary endpoint of a prescription fill for a high-intensity statin treatment (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) that commenced on or covered ±30 days of the index date of Jan. 31, 2019. Moreover, 49.9% were not on any statin therapy and 27.6% were on low- or moderate-intensity statin.

Nearly two-thirds of patients in the no-statin group had seen their cardiologist in the previous 12 months and more than 80% of patients with lower levels of adherence had seen their cardiologist or primary care physician in the previous 12 months.

Characteristics associated with a lower likelihood of being prescribed any statin were younger age (<45 years), being a woman, and a higher Charlson comorbidity score, as shown on multivariable analysis. Furthermore, among statin users, patients less likely to be on a high-intensity statin were women, older or have PAD. Of note, however, is that adherence was high (83.7%) among those taking a high-intensity statin.

The authors note this is one of the largest contemporary analyses of statin prescribing habits in the U.S. and with >20,000 patients younger than 45 years old one of the largest to evaluate statin use in very premature ASCVD. “Our concerning finding that only 22.4% of ‘younger’ patients were using a statin likely reflects a knowledge gap around premature ASCVD contributing to underuse at both the patient and clinician level.” They also note their data provides more evidence of the undertreatment of women and “confirms that patients with PAD continue to represent a neglected ASCVD subgroup with respect to statin use.”

In an accompanying editorial comment, Salim S. Virani, MD, FACC, et al., write “In a remarkable show of unanimity, all guidelines, including those from the [ACC] and the American Heart Association, recommend high-intensity statin therapy as a Class I recommendation in patients with ASCVD. It is puzzling, then, that the use of statins and high-intensity statins remains low in these patients.” They state there are likely multiple barriers at the level of individual clinicians, patients and their social network, and the health care system that have led to low use of statin therapy. This study "serves as yet another call to action for us to intensify our efforts to improve provision of a lifesaving therapy to our high-risk patients," they write.

Clinical Topics: Cardiovascular Care Team, Dyslipidemia, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Atherosclerosis, Cholesterol, LDL, Pharmacy, Comorbidity, Prescriptions, Social Networking, Delivery of Health Care, Cerebrovascular Disorders, Peripheral Arterial Disease, Physicians, Primary Care, Retrospective Studies, Coronary Artery Disease, Cardiovascular Diseases, Atorvastatin, Rosuvastatin Calcium, Hydroxymethylglutaryl-CoA Reductase Inhibitors

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