Tunnel vision? Many high-risk patients not prescribed statins

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Those patients most likely to benefit from statin therapy may be overlooked by physicians who focus on cholesterol levels rather than overall cardiovascular risk. A study published in the May/June issue of Annals of Family Medicine determined that more than 14 million at-risk patients were undertreated in the U.S. 

The findings support the 2013 prevention guidelines by the American Heart Association/American College of Cardiology, which do away with target cholesterol goals, lead author Michael Edward Johansen, MD, MS, told Cardiovascular Business. “The findings are far more dramatic than I thought they would be,” he said.

Johansen, of Ohio State University in Columbus, and colleagues wanted to examine the role risk factors play in statin prescribing in the U.S. They used the Medical Expenditure Panel Survey from 2010, which includes self-reported medical conditions and prescription data, for a nationally representative sample.

The primary outcome was statin use, defined as filling two or more statin prescriptions. They conducted two analyses; one for the entire sample and a second based on only those participants diagnosed with heart disease or diabetes. Statin use has been shown to reduce the risk of future cardiovascular events in patients with coronary heart disease or diabetes.

The study cohort included 16,712 participants 30 to 79 years old. Of those, 38 percent had a diagnosis of hyperlipidemia, and of them, 47 percent were on statins.

Eight percent of the sample group had coronary artery disease, 58 percent of whom were on statins. Of those patients with coronary artery disease but not hyperlipidemia, only 16 percent took statins. Another 11 percent of patients had diabetes and were older than 40 years, with 52 percent on statins. Of those with diabetes but not hyperlipidemia, only 12 percent were on statins. Hyperlipidemia was the strongest predictor of statin use.

Calculating the undertreatment at a national level, Johansen and colleagues estimated that 5.6 million patients with coronary artery disease and 9 million with diabetes who were older than 40 were not receiving regular statin therapy.

“[T]his pattern strongly supports the notion that statin use is being driven by hyperlipidemia instead of overall cardiovascular risk,” they wrote. “Given that the absolute benefit of statins is related to a patient’s overall risk, this finding is problematic.”

The new guidelines also include a risk estimator that is expected to expand the population eligible for statin therapy to lower risk groups, which the authors question. “The most benefit is focusing on those high-risk patients who are not taking statins,” Johansen said.