Statin Therapy Underutilized in Treatment-Eligible Adults in the United States

There is a significant opportunity to improve statin utilization in adults who are eligible for, but are not on, statin therapy in the United States, according to study results published in the Journal of the American Heart Association.¹

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality, with almost half of US adults projected to have some form of ASCVD by 2030.² Although statins are among the most effective medications for the prevention of ASCVD,³ a large gap in statin use remains between guidelines and actual clinical practice.^4-6

Thus, researchers analyzed data from 5693 adults recommended for statin therapy in the Patient and Provider Assessment of Lipid Management registry to evaluate patient-reported reasons for statin underutilization, including non-initiation, refusal, and discontinuation.¹

They found that overall, 1511 (26.5%) adults were not on treatment, and of these, 894 (59.2%) reported never being offered a statin, 153 (10.1%) declined a statin, and 464 (30.7%) had discontinued treatment.

Women, black adults, and patients without insurance were most likely to report never being offered a statin, while fear of adverse events and perceived adverse events were the most likely reasons for declining or discontinuing a statin.

However, willingness to take a statin was high, with 67.7% of patients never offered and 59.7% of patients who discontinued a statin saying they would consider initiating or retrying a statin.

The investigators concluded that, “Addressing patient perception of statin safety, especially among patients who decline or discontinue statin therapy, may improve statin utilization.”¹ In addition, “Patients who previously discontinued their statin may be receptive to retrying one if offered by their physician.”

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References

1. Bradley CK, Wang TY, Li S, et al. Patient-reported reasons for declining or discontinuing statin therapy: insights from the PALM registry. J Am Heart Assoc. 2019;8:e011765.
2. Benjamin EJ, Blaha MJ, Chiuve SE, et al ; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135:e146-e603.
3. Baigent C, Keech A, Kearney PM, et al; Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005;366:1267-1278.
4. Maddox TM, Borden WB, Tang E, et al. Implications of the 2013 ACC/AHA cholesterol guidelines for adults in contemporary cardiovascular practice: insights from the NCDR PINNACLE registry. J Am Coll Cardiol. 2014;64:2183-2192.
5. Pokharel Y, Tang F, Jones PG, et al. Adoption of the 2013 American College of Cardiology/American Heart Association cholesterol management guideline in cardiology practices nationwide. JAMA Cardiol. 2017;2:361-369.
6. Pokharel Y, Gosch K, Nambi V, et al. Practice-level variation in statin use among patients with diabetes: insights from the PINNACLE registry. J Am Coll Cardiol. 2016;68:1368-1369.

This article originally appeared on The Cardiology Advisor