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Trends in Primary Prevention Statin Use by Cardiovascular Risk Score

Statin use has plateaued at 35% of adults with little change since the release of the 2013 guidelines that expanded the number of Americans with recommendations for primary prevention, a study shows. “Most adults with guideline recommendations for primary prevention statins are not receiving them, including those with diabetes or a low-density lipoprotein cholesterol level above 4.92 mmol/L (190 mg/dL), indicating that novel efforts, informed by implementation science and targeting patients with the greatest risk, are urgently needed,” the authors conclude. The American College of Cardiology and the American Heart Association (ACC/AHA) in their 2013 guidelines recommended using cardiovascular disease (ASCVD) risk scores. This made treatment decisions more complex, compared with the 2002 Adult Treatment Panel III guidelines based primarily on LDL cholesterol levels, presence of ASCVD, and the number of risk factors.

The current study used NHANES data from 1999 to 2018 to obtain information on 21,961 adults chosen in a weighted sample of the total data. Participants were categorized based on criteria for statin use by only the 2002 Adult Treatment Panel III guidelines, by only the 2013 ACC/AHA guidelines, or by both guidelines.

“Between 1999 to 2000 and 2013 to 2014, the proportion of guideline-eligible adults who reported receiving statins increased from 11.6% (CI, 7.7% to 15.6%) to 33.6% (CI, 27.5% to 39.6%), an increase of 22.0 percentage points (CI, 14.7 to 29.2 percentage points),” the authors write. “Between 2013 to 2014 and 2017 to 2018, there was no change in statin use (change, −1.2 percentage point [CI, −8.6 to 6.3 percentage points]).

“For adults newly recommended statins by the 2013 ACC/AHA guidelines, the proportion using statins did not change between 2013 to 2014 and 2017 to 2018 (change, −2.1 percentage points [CI, −15.1 to 11.0 percentage points]). Adults with diabetes had an increase of 31.1 percentage points (CI, 21.0 to 41.2 percentage points) in the proportion using statins between 1999 to 2000 and 2013 to 2014 but no change between 2013 to 2014 and 2017 to 2018 (change, 6.8 percentage points [CI, −7.3 to 21.0 percentage points]). Adults with ASCVD risk above 20% had an increase in statin use between 1999 to 2000 and 2013 to 2014 (change, 23.1 percentage points [CI, 11.4 to 34.8 percentage points]) but not between 2013 to 2014 and 2017 to 2018 (change, −0.4 percentage point [CI, −13.2 to 12.3 percentage points]). Among adults with an indication based on ASCVD risk, patterns of statin use were similar over time among the 3 groups of ASCVD risk.”

Source: Annals of Internal Medicine