A little less than half of atherosclerotic cardiovascular disease (ASCVD) patients are treated for blood cholesterol according to 2013 clinical guidelines, with around half missing out on a statin prescription the guidelines would have recommended, according to a study published in the American Journal of Cardiology.
The 2013 American College of Cardiology/American Heart Association guidelines for treating blood cholesterol to reduce ASCVD recommended statin therapy for all adult patients with known CVD, regardless of their LDL-cholesterol (LDL-C) level, corresponding author Joseph Menzin, PhD, and colleagues wrote in AJC. The organizations’ 2018 update maintained that recommendation.
“Various literature have explored the impact of the 2013 ACC/AHA guidelines on U.S. cardiovascular practices, including physician prescribing patterns, changes in patients’ adherence to and initiation of statin therapy and implications for defining treatment targets,” the authors said. “The majority of these analyses have concluded that a large proportion of statin-eligible patients are not receiving guideline-recommended lipid-lowering therapy after an acute cardiovascular event, however the reasons for this deficit largely remains unknown.”
Menzin and co-authors used data from electronic medical records (EMRs) and chart reviews to size up the situation in 2019, pulling information for 4,106 ASCVD patients who were treated according to the 2013 ACC/AHA guidelines (2018 guidelines hadn’t been released at the time of the study’s baseline). The team also noted the reasons physicians prescribed certain treatments, a metric that was included in clinical notes.
The researchers found that less than half of the patients they analyzed were treated according to 2013 guidelines, with around 30% of patients not receiving a statin at all. Physicians were more likely to adhere to guidelines if a patient had experienced MI versus other presentations of ASCVD.
Menzin et al. delved further into a randomized sample of 428 patients, the majority (64%) of whom were prescribed a statin within 12 months of an index visit for ASCVD. Although prescriptions seemed more prevalent in the population, the authors said treatment often didn’t meet 2013 statin intensity requirements—58% of patients prescribed a statin that didn’t meet intensity guidelines were prescribed a moderate-intensity statin, while 42% were prescribed a low-intensity statin. Most patients prescribed a statin below the recommended intensity threshold were under 75 years of age at index; the majority of patients who weren’t prescribed a statin at all were older.
The remaining 36% of the researchers’ subgroup weren’t prescribed any statin therapy within a year of being diagnosed with ASCVD, and 64% of their physicians provided reasons for that decision. The most common were muscle-related adverse events prior to the ASCVD index date, patient requests or refusals, LDL-C stability and LDL-C goal achievement.
Menzin and colleagues said that since their subgroup analysis was conducted in a random sample results might not be generalizable to the broader ASCVD population, but they still shed light on a critical issue.
“The results of this analysis are still highly relevant even to current guidelines,” they wrote. “Physician and patient education on the importance of adherence to guideline-recommended lipid-lowering therapy, particularly among this high-risk patient population, should be emphasized.”