Despite the fact that statins have been widely known to decrease the risk of cardiovascular events, there remains room for improvement in the treatment of obstructive coronary artery disease (CAD) patients, according to results of a study published in the Nov. 29 issue of Circulation. In fact, the researchers found that nearly 17 percent of patients were left untreated.
“Although randomized clinical trials have consistently demonstrated that secondary prevention treatment with statins substantially reduces recurrent cardiovascular events and mortality in patients with obstructive coronary artery disease (CAD), the extent to which these high-risk patients are treated with statin, nonstatin or no lipid-lowering therapy in the outpatient cardiology setting is largely unknown,” Suzanne V. Arnold, MD, MHA, of the Saint Luke’s Mid America Heart Institute in Kansas City, Mo., and colleagues wrote.
To better understand the trends among statin administration in patients with obstructive CAD, Arnold et al evaluated statin and nonstatin use in 38,775 CAD patients using the American College of Cardiology’s PINNACLE registry. Of the cohort, 77.8 percent of patients were prescribed statins, 5.3 percent were treated with nonstatin lipid-lowering medications and 17 percent were untreated.
The authors reported that lack of medical insurance was associated with no statin treatment, while males, those with hypertension and those undergoing a recent revascularization procedure, were more likely to be administered statins.
LDL-cholesterol levels were available for 51.2 percent of patients not on any lipid-lowering therapies and among untreated patients, LDL-cholesterol levels were less than 100 mg/dL in 53.3 percent of patients and 100 mg/dL or greater in 46.7 percent of patients.
From these results the authors concluded that one in five patients with obstructive CAD and without contraindications were not treated with statins.
“Collectively, these findings suggest there are significant opportunities for improvement in the quality of lipid management for a substantial number of outpatients with obstructive CAD,” the authors wrote.
“Our finding that half of untreated patients had an LDL-C of less than 100 mg/dL raises concerns about missed opportunities for intensive secondary prevention in patients with documented obstructive CAD,” the authors wrote. “[O]ur data suggest that some physicians may be making decisions about lipid management for these patients based on baseline LDL-C levels alone.”
Arnold et al summed that these results outline the importance of improving statin use in obstructive CAD patients who are at a high risk for CV events.
The researchers noted that a limitation to the study could be that factors identifying the reason why patients did not receive statin treatment remains unknown.