High-intensity statins underused with atherosclerotic cardiovascular disease

Among patients with atherosclerotic cardiovascular disease (ASCVD), high-intensity statins are underutilized in routine care, according to a study published online Aug. 2 in Circulation: Cardiovascular Quality and Outcomes.

Ann Marie Navar, M.D., Ph.D., from University of Texas Southwestern Medical Center in Dallas, and colleagues examined use of statins and other lipid-lowering therapy (LLT) and changes in low-density lipoprotein cholesterol (LDL-C) among patients with ASCVD. The analysis included electronic health record-derived data from outpatient visits for 322,153 patients with ASCVD (Cerner Real-World Data from 92 U.S. health systems 2017 through 2018).

The researchers found that 76.1 percent of patients were on statins, with only 39.4 percent on high-intensity statins. Compared with women, men were more likely to receive high-intensity statins (multivariable-adjusted odds ratio [OR], 1.34). Lower odds of statin use were seen with increasing age (OR, 0.79 per five-year increase at 60 years). Compared with patients with coronary heart disease, patients with peripheral artery disease (OR, 0.40) and cerebrovascular disease (OR, 0.75) had lower odds of using high-intensity statins. Most patients (61.3 percent) at baseline had elevated LDL-C (≥70 mg/dL), including 59.8 percent of those on low/moderate-intensity statins and 76.1 percent on no statin. At one year, only 45.3 percent achieved an LDL-C <70 mg/dL. Nonstatin LLT use was low. Among patients on no statin or low/moderate-intensity statin at baseline, at one year, 14.8 and 13.4 percent, respectively, were on high-intensity statins.

"Concerted efforts are needed to address therapeutic inertia for lipid management in patients with ASCVD," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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