Author + information
- Fatima Rodriguez,
- Joshua Knowles,
- David Maron,
- Salim Virani and
- Paul Heidenreich
Background: Individuals with LDL-C levels above 190 mg/dL are considered to have a severe hypercholesterolemia phenotype and are at markedly increased risk of adverse cardiovascular events. Therefore, the 2013 ACC/AHA cholesterol guidelines recommend high-intensity statins for this high-risk patient group, irrespective of comorbidities. Little is known about the severe hypercholesterolemia population in the Veteran's Affairs (VA) Health System and how practice patterns in statin prescribing have impacted this patient group.
Methods: Our study population was comprised of VA outpatients ≥21years of age without established atherosclerotic disease or diabetes mellitus and an LDL-C ≥190 mg/dL during 4/2012-3/2014. Patients needed to have filled medications at the VA within the past 6 months. Statin intensity was defined by the ACC/AHA guidelines. Patient and facility-level predictors of statin use for were analyzed using multivariate logistic regressions.
Results: There were a total of 73,752 patients meeting the inclusion criteria, including 10,469 (14.2%) women and 20,384 (29.0%) non-white patients. The mean ± S.D. age was 55±13 years and the mean of the most recent LDL-C values was 193±13 mg/dL. Only 52% of all eligible patients were on any statin therapy and 9.7% received a high-intensity statin. Patients under 35 or over 75 years of age were less likely to be on a statin as compared with other age groups (p<0.001). In multivariate models, women were less likely to be on a statin as compared with men, odds ratio (OR)=0.83; 95% CI (0.80, 0.87). Blacks were more likely to be on statins as compared with whites, OR=1.26; 95% CI (1.21,1.32), as were those with a diagnosis of hypertension [OR=1.10; 95% CI (1.06, 1.13)].
Conclusions: In high-risk VA patients with a severe hypercholesterolemia phenotype, only half are being treated with a statin and a small minority (less than 10%) are on high-intensity statins. Younger and older adults are less likely to be treated with statins, as are women. These findings identify a large gap in translating guidelines into practice for high-risk VA patients.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Advances in Cholesterol Measurement and Management
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1106-039
- 2017 American College of Cardiology Foundation