Clinical InvestigationUse of high-intensity statins for patients with atherosclerotic cardiovascular disease in the Veterans Affairs Health System: Practice impact of the new cholesterol guidelines
Section snippets
Background
The 2013 cholesterol treatment guidelines by the American College of Cardiology (ACC) and American Heart Association (AHA) have shifted away from low-density lipoprotein cholesterol (LDL-C) targets and instead recommend high-intensity statin therapy for patients based on risk profiles ≤75 years of age1 because of growing evidence from large clinical trials that higher-intensity statins decrease risk more effectively than lower-intensity statins.2., 3., 4. This paradigm shift provides a
Study population
We created partially overlapping cohorts of patients at quarterly intervals beginning in 2013 (index dates April 1, 2013; July 1, 2013; October 1, 2013; January 1, 2014; and April 1, 2014). Each cohort included all outpatients within the VA Health System ≥21 and ≤75 years of age with at least 1 atherosclerotic cardiovascular disease (ASCVD) code on 2 different dates during the 12 months prior to the index date. ASCVD was defined as coronary artery disease (CAD, International Classification of
Results
Overall statin use (any intensity) remained comparable from 78.4% among 331,927 patients with ASCVD before the release of the cholesterol guidelines to 77.7% among 326,759 patients after the release. Prior to the release of the new guidelines only 28.2% of ASCVD patients were on a high-intensity statin; this increased to 34.9% after the guideline release (P < .0001). Table I compares the characteristics of ASCVD patients on high-intensity statins before and after the release of the new guideline.
Discussion
In this national study of VA patients with established ASCVD, we found that 78% of high-risk patients were on any statin therapy and only 28% were receiving a high-intensity statin just prior to the release of the ACC/AHA cholesterol treatment guidelines. Despite this, evidence continues to show that statins are underused even in the highest-risk patient groups.7., 8., 9., 10., 11., 12. Although well below recommendations, this rate of statin use is higher than data from community settings.14
Conclusions
Although high-intensity statin use has increased significantly within the VA system for all ASCVD and racial/ethnic groups following release of the ACC/AHA cholesterol treatment guideline, the frequency of use remains disappointingly low. Furthermore, disparities persist, with lower use of high-intensity statins among older adults, women, certain racial and ethnic minorities, PAD and cerebrovascular disease patients, and patients not cared for at academic facilities. Our findings highlight the
Disclosures
The authors have no relevant disclosures or relationships with industry to report.
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