Abstract 13047: Are Clinicians Using All Available Strategies to Achieve Guideline-Recommended Lipid Lowering?

• Published in: Circulation (New York, N.Y.) Vol. 146; no. Suppl_1
• Main Authors: Navar, Ann M, Gupta, Anand, Gillard, Kristin K, Israel, Marc, Peterson, Eric D
• Format: Journal Article
• Language: English
• Published: 08.11.2022
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.146.suppl_1.13047

Abstract only Introduction: Despite their safety, efficacy, and low-cost, statins are under-utilized in both primary and secondary prevention populations. Multiple strategies are available to facilitate lipid lowering in those who report statin intolerance including using alternate statins, low-intensity or alternate-day statin dose schedules, or using non-statin lipid lowering therapies. However, the degree to which these alternative strategies are tried in community practice is unknown. Methods: We evaluated prior statin use among n=731,895 persons who met guideline recommendations for statin therapy between 2017-2018 in Cerner RealWorldData, an electronic health record (EHR)-based dataset from 94 health systems. Medication data available included all prescriptions generated from the EHR and self-reported medications recorded in the EHR (median of 4 years of medication data for each subject). Results: Among 731,895 individuals who met guideline recommendations for statin therapy, 278,434 (38.0%) were not on a statin. Of those not on a statin, only 20.1% (n=55,875) had any evidence of prior statin therapy, and 12.3% had documentation of a statin allergy. Among prior statin users,most had only tried one (68.0%) or two (23.5%) statins before stopping all together. Only 1.3% of former statin users had been prescribed a statin at less than daily frequency, while 22.6% had been prescribed a low-intensity statin at some point in the past. Utilization of non-statin lipid lowering therapy was also rare: Among those not on a statin, only 2.6% were on ezetimibe, 4.4% were taking a fibrate, 1.5% a bile acid sequestrant, 1.6% niacin, and 0.3% were taking on a PCSK9 inhibitor. Conclusion: Across 94 health systems, almost 40% of persons recommended for statin therapy for primary or secondary prevention were not on a statin, the vast majority of which had no evidence of prior statin utilization. Of those who had tried a statin in the past but discontinued therapy, very few appeared to have attempted a re-challenge with a different statin, tried alternative dosing strategies to improve tolerability, or initiated non-statin lipid lowering therapy.