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High-Intensity Statin Use Among Patients With Atherosclerosis
Quick Takes
- Of >600,000 patients with ASCVD who have health insurance, in 2018-2019, only 50% of men and women were on statins and 22.5% on high-intensity statins.
- This is despite >80% had a primary care or cardiology office visit in the previous year.
- Among statin users, female patients, older patients, and those with peripheral artery disease were less likely to be on a high-intensity statin, whereas a cardiology encounter in the prior year increased the odds.
Study Questions:
What are the patterns and predictors of statin use among patients with atherosclerotic cardiovascular disease (ASCVD)?
Methods:
This was a retrospective cohort study of pharmacy and medical claims data from Healthcore Integrated Research Environment (HIRE), a repository of claims in a commercial health plan. Patients were identified 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 (high-intensity atorvastatin 40-80 mg or rosuvastatin 20-40 mg).
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 a 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 statin 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.
Perspective:
HIRE is a subsidiary of Anthem, which can provide de-identified medical and pharmacy claims for >48 million persons and lab results from >17 million individuals. It provides life science investigators the opportunity to answer questions regarding the utility or potential utility of health care products from the real world and not in a clinical trial setting. In a study of >600,000 patients with ASCVD who had health insurance, only 50% were taking a statin and <25% were on a high-intensity statin. The results are incredibly disappointing regardless of the contribution of statin intolerance, patient refusal or discontinuation, medical comorbidities, and life expectancies. And >80% had seen a primary care physician or cardiologist in the prior 12 months.
Clinical Topics: Dyslipidemia, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Novel Agents, Statins
Keywords: Atherosclerosis, Atorvastatin, Comorbidity, Delivery of Health Care, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Insurance, Health, Peripheral Arterial Disease, Physicians, Primary Care, Primary Prevention, Rosuvastatin Calcium, Secondary Prevention, Vascular Diseases
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