Implications of the 2013 ACC/AHA Cholesterol Guidelines for Adults in Contemporary Cardiovascular Practice

• Published in: Journal of the American College of Cardiology Vol. 64; no. 21; pp. 2183 - 2192
• Main Authors: Maddox, Thomas M., MD, MSc, Borden, William B., MD, Tang, Fengming, MS, Virani, Salim S., MD, PhD, Oetgen, William J., MD, MBA, Mullen, J. Brendan, BSFS, Chan, Paul S., MD, MSc, Casale, Paul N., MD, Douglas, Pamela S., MD, Masoudi, Fredrick A., MD, MSPH, Farmer, Steven A., MD, PhD, Rumsfeld, John S., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 02.12.2014; Elsevier Limited
• Subjects: Cardiology; Cardiovascular; Cardiovascular disease; cardiovascular diseases; Cholesterol; Classification; cohort studies; Diabetes; Heart attacks; Heart failure; hydroxymethylglutaryl-coA reductase inhibitors; Hypertension; Internal Medicine; Lipids; Medical records; Older people; primary prevention; secondary prevention; United States > US; ACC; secondary prevention; ASCVD; LDL-C; low-density lipoprotein cholesterol; cardiovascular diseases; atherosclerotic cardiovascular disease; Adult Treatment Panel; hydroxymethylglutaryl-coA reductase inhibitors; American College of Cardiology; American Heart Association; cohort studies; primary prevention; cholesterol; AHA; ATP
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2014.08.041

Abstract Background In a significant update, the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines recommend fixed-dose statin therapy for those at risk and do not recommend nonstatin therapies or treatment to target low-density lipoprotein cholesterol (LDL-C) levels, limiting the need for repeated LDL-C testing. Objectives The goal of this study was to examine the impact of the 2013 ACC/AHA cholesterol guidelines on current U.S. cardiovascular practice. Methods Using the NCDR PINNACLE (National Cardiovascular Data Registry Practice Innovation and Clinical Excellence) registry data from 2008 to 2012, we assessed current practice patterns as a function of the 2013 cholesterol guidelines. Lipid-lowering therapies and LDL-C testing patterns by patient risk group (atherosclerotic cardiovascular disease [ASCVD], diabetes, LDL-C ≥190 mg/dl, or an estimated 10-year ASCVD risk ≥7.5%) were described. Results Among a cohort of 1,174,545 patients, 1,129,205 (96.1%) were statin-eligible (91.2% ASCVD, 6.6% diabetes, 0.3% off-treatment LDL-C ≥190 mg/dl, 1.9% estimated 10-year ASCVD risk ≥7.5%). There were 377,311 patients (32.4%) not receiving statin therapy and 259,143 (22.6%) receiving nonstatin therapies. During the study period, 20.8% of patients had 2 or more LDL-C assessments, and 7.0% had more than 4. Conclusions In U.S. cardiovascular practices, 32.4% of statin-eligible patients, as defined by the 2013 ACC/AHA cholesterol guidelines, were not currently receiving statins. In addition, 22.6% were receiving nonstatin lipid-lowering therapies and 20.8% had repeated LDL-C testing. Achieving concordance with the new cholesterol guidelines in patients treated in U.S. cardiovascular practices would result in significant increases in statin use, as well as significant reductions in nonstatin therapies and laboratory testing.