AHA 2017: Concerns about safety appear to influence statin use in community practice

November 14, 2017 – Healthcare practitioners’ use of statins did not correlate with their reported knowledge and adoption of the 2013 American College of Cardiology/American Heart Association (AHA/ACC) cholesterol guidelines, say researchers.

A recent study by DCRI researchers presented at the annual AHA conference in Anaheim, California, aimed to describe how clinician knowledge and beliefs regarding statin therapy are associated with lipid treatment practices since the release of the 2013 ACC/AHA Cholesterol Guidelines.

“Treatment with statin therapy for primary and secondary prevention of cardiovascular disease has been shown in many studies to have significant benefits,” said the DCRI’s Angela Lowenstern, MD, first author of the study. “It is important to understand the role that clinician characteristics play in patient treatment practices, particularly after the recent shift in guideline recommendations that describe how clinicians should treat blood cholesterol and what goals they should have for patient treatment.”

Developed in collaboration with the National Heart, Lung, and Blood Institute and stakeholder and professional organizations, the 2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults are clinical practice guidelines for the assessment of cardiovascular risk, lifestyle modifications to reduce cardiovascular risk, management of blood cholesterol in adults, and management of overweight and obesity in adults. They are in line with the organizations’ goal to prevent cardiovascular diseases and improve the management of people who have these diseases through professional education and research.

The researchers administered a survey to practitioners taking care of patients enrolled in the Patient and Provider Assessment of Lipid Management (PALM) Registry, designed to gain a better understanding of physicians’ cholesterol medication prescribing practices, patient and physician attitudes and beliefs related to cholesterol management, and current utilization of cholesterol-lowering therapies given the new ACC/AHA Cholesterol Guideline recommendations. The survey assessed knowledge and adoption of the 2013 ACC/AHA Cholesterol Guideline recommendations, as well as belief in statin benefit and concerns regarding statin risk.

“We found that there was a positive association between clinicians who believed in the benefit of statin medications and those who also adopted the 2013 ACC/AHA Cholesterol Guideline recommendations,” said Lowenstern.

The researchers found that clinicians with concerns regarding the safety of statin therapy were less likely to adopt the 2013 ACC/AHA guideline recommendations. Additionally, clinician biases regarding the safety of treatment with statin medications led to reduced statin prescribing and reduced ability to achieve an optimal LDL cholesterol of <100 mg/dL. The study also showed that clinician biases regarding statin therapy can lead to differences in patient treatment practices.

According to Lowenstern, the study also found that compared to non-cardiologists, cardiologists were more likely to adopt the 2013 ACC/AHA Cholesterol Guideline recommendations, more likely to believe in the benefit of treatment with statin medications and less likely to have concerns regarding the safety of statin therapy. Clinicians working in teaching hospitals were also more likely to implement the recommendations as compared to those working in non-academic settings. Clinicians with less than or equal to 10 years in practice were also more likely to adopt the recommendations but less likely to believe in the overall benefit of statin medications as compared to clinicians in practice greater than 10 years. There was no observed difference between the groups with regards to guideline knowledge or concerns regarding the safety of statin therapy.

“This research is valuable because it gives us information regarding clinician characteristics that can play a role in patient statin treatment,” said Lowenstern. “Determining ways in which we can continue to improve treatment of our patients with guideline recommended statin therapy is the next step.”

In addition to Lowenstern, other researchers included Ann Marie Navar, Shuang Li, Anne C. Goldberg, Michael J. Louie, L. Veronica Lee, Salim Virani, Eric D. Peterson and Tracy Y. Wang.