Nonadherence to statin guidelines for primary prevention may lead to an elevated risk of atherosclerotic cardiovascular disease (ASCVD) events in intermediate- and high-risk patients, according to new data published in Circulation: Cardiovascular Quality and Outcomes.
“Primary prevention strategies based on pharmacological lowering of low-density lipoprotein cholesterol in appropriately selected patients can lower the risk of atherosclerotic cardiovascular diseases,” wrote lead author Anum Saeed, MD, University of Pittsburgh Medical Center, and colleagues. “However, guideline recommended statin use for primary prevention of atherosclerotic cardiovascular disease remains an area without clear uniformity.”
Using electronic medical health records, researchers evaluated statin prescription in patients without coronary artery disease (CAD), peripheral vascular disease or ischemic stroke who received care in a large health care network from 2013 to 2017.
Among 282,298 patients, 10.3%, 22.4%, and 9.5% were categorized as borderline, intermediate, and high risk, respectively. Fifty-six percent of patients were women, and the mean patient age was 50 years old.
In the analysis, 43% of intermediate-risk patients and 31% of high-risk patients never received any statin therapy.
Among patients who did receive such therapies, 54% of intermediate-risk patients and 65.5% of high-risk patients achieved optimal guideline-directed statin intensity (GDSI) over the entire follow-up period. For that group, the mean time to GDSI was approximately two years.
Reviewing the data, including a median follow-up period of six years, the authors observed "a graded increase" in ASCVD events among intermediate- and high-risk patients who did not take statins as recommended. There was also an elevated risk of mortality among patients who weren't on statin therapy compared to those that achieved GDSI.
“The consequences of nonadherence to guidelines are illustrated by greater incident ASCVD and mortality events," the researchers wrote. "Further research can develop and optimize healthcare system strategies for primary prevention."
Read the entire study here.