Guidelines impact cholesterol management

BACKGROUND: Previous research demonstrates increased utilization of high-intensity statins, but unchanged low-density lipoprotein cholesterol (LDL-C) levels, immediately after the 2013 American College of Cardiology (ACC) and the American Heart Association (AHA) guideline release. OBJECTIVE: The objective of this study was to determine achievement of statin therapy goals in patients with atherosclerotic cardiovascular disease (ASCVD) before and up to 4 years after the 2013 ACC/AHA guideline release compared with LDL-C goals of <70 mg/dL and <100 mg/dL previously recommended by other professional societies. METHODS: The single-system cohort study used medical records, laboratory results, and claims data (November 2012-October 2017) of adults with claim for a statin, ASCVD diagnosis in propensity score-matched analyses. RESULTS: Among 1938 patients (mean age 70 11, 48% female) with ASCVD, the percentage on high-intensity statin therapy significantly increased over time: 24% in 2013, 34% 2014, 42% 2015, and 49% 2016 (P<.0001). The increase in high-intensity statin use was 13 to 22% higher among patients managed by subspecialists (cardiologist and endocrinologists) compared with those managed by primary care providers. Mean LDL-C level was slightly, but not significantly, lower in 2013 (80 mg/dL) than in other years: 85 mg/dL in 2014, 83 mg/dL in 2015, and 82 mg/dL in 2016. The proportion of patients reaching LDL-C goals ranged from 51% to 56% for the <70 mg/dL target and 77% to 85% for the <100 mg/dL target over time. CONCLUSION: High-intensity statin use among secondary prevention patients increased significantly immediately after the 2013 ACC/AHA guidelines release, primarily in those managed by sub specialists. However, the mean LDL-C and the proportion of patients reaching LDL-C <70 mg/dL and < 100 mg/dL remain unchanged across comparison cohorts. (C) 2019 National Lipid Association. All rights reserved.