December 5, 2017 – Among patients who are on statins, less than half receive the recommended dosage.
Many physicians who prescribe statins for hyperlipidemia, or elevated cholesterol levels, are not in line with the most recent guidelines, according to a new study by DCRI researchers.
High levels of low-density lipoprotein (LDL), or “bad” cholesterol, can lead to greater risk of heart disease and stroke. Approximately 71 million Americans have elevated LDL levels, and only 1 in 3 adults with high LDL have the condition under control.
In 2013, the American Heart Association (AHA) and American College of Cardiology (ACC) issued new guidelines for the treatment of high LDL. These guidelines represented a change from previous recommendations, placing an emphasis on cardiovascular risk assessment to determine who is eligible for treatment and pushing for use of high-dose statins rather than a treat-to-target strategy.
The Patient and Provider Assessment of Lipid Management (PALM) registry was designed to determine how closely current clinical practice reflects the AHA/ACC guidelines. PALM’s primary results were published recently in the American Heart Journal.
“While there’s been a lot of focus on people who are not any statin, there has been less emphasis on whether they are on the right recommended dose of statin,” said the DCRI’s Ann Marie Navar, MD, PhD, who led the study.
PALM enrolled more than 7,900 patients from 138 sites across the United States. These patients included adults on statins, adults at high risk of atherosclerotic cardiovascular disease (ASCVD), and adults with prior ASCVD. The researchers collected information from patient surveys, core laboratory lipid panels, and other medical records to assess current lipid-lowering therapy in high-risk groups.
Navar and her colleagues found that while 74.7 percent of eligible adults were on statins, only 57 percent of those on statins were on guideline-recommended intensity. Overall, only 42.4 percent of adults were on a statin at the recommended dose. ASCVD patients were more likely to be on a statin than other patients (83.6 percent versus 63.4 percent) and were also more likely to receive guideline-recommended therapy (47.3 percent versus 36.0 percent). Men were more likely than women to be prescribed the recommended intensity for both primary and secondary prevention.
In primary prevention, increasing age, diabetes, obesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving the recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients, as were those seen by cardiologists. Median LDL levels were highest among patients not on statins and slightly higher among those on lower-than-recommended intensity compared with recommended-therapy recipients.
These findings, Navar said, illustrate the need to identify both high-risk patients not currently on statin therapy, as well as patients currently on a statin who could benefit from more intensive treatment.
“People on a low or moderate dose of a statin should ask their doctor if they are eligible for a higher dose,” Navar said. “This can further lower their cholesterol and their risk of heart attack and stroke.”
In addition to Navar, the study’s other DCRI authors included Tracy Y. Wang, MD, MHS, MSc; Shuang Li, MS; and Eric D. Peterson, MD, MPH.