Statin Use Remains Low for At-Risk Patients

TOPLINE:

Changes in statin prescribing guidelines in 2013 had little effect on statin use for patients who are at risk for atherosclerotic cardiovascular disease (ASCVD), according to a study published in the Annals of Internal Medicine. 

METHODOLOGY:

• Statins lower cholesterol and can reduce the risk for heart and circulatory disease.

• In 2013, the American College of Cardiology and the American Heart Association (ACC/AHA) expanded indications for which clinicians could prescribe statins to adults for primary prevention, including risk scores for ASCVD above a certain threshold. 

• Researchers studied trends in statin use between 1999 and 2018 using National Health and Nutrition Examination Survey data for 21,961 adults older than 20 years who did not have ASCVD. 

• They analyzed data from before and after implementation of the 2013 guidelines.

TAKEAWAY:

• Statin usage increased since 1999 but peaked at 35% in 2013 despite the expanded ACC/AHA guidelines.

• No changes in usage were observed for the proportion of adults who were newly eligible for statins. 

• Statin use among patients with diabetes increased by 31.1 percentage points between 1999 and 2014 but then remained stagnant from 2014 to 2018.

• Statin use among those with ASCVD risk of more than 20% increased by 23.1 percentage points between 1999 and 2013 but did not increase between 2013 and 2018.

IN PRACTICE:

"Although the ACC/AHA guidelines expanded indications for primary prevention, they also increased decision-making complexity, requiring new multistep risk calculation…Many clinicians do not routinely use cardiovascular risk calculators because of a lack of time, input availability, or buy-in. Electronic health record tools that calculate ASCVD risks show promise, but they are not routinely implemented and do not address other barriers, such as competing patient priorities and limited time for shared decision-making."

SOURCE:

The study was led by Timothy S. Anderson, MD, MAS, Division of General Internal Medicine, at the University of Pittsburgh. The research was funded by the National Institute on Aging of the National Institutes of Health.

LIMITATIONS:

Data on whether patients had previously been offered and declined statins were not available. Risk score data for baseline ASCVD, which affects risk classification, were also not available.

DISCLOSURES:

The authors report no disclosures.

Brittany Vargas is a medicine, mental health, and wellness journalist.