Abstract 14224: Patient Differences in Prescription Patterns for Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors When More Intensive Therapy is Needed

• Published in: Circulation (New York, N.Y.) Vol. 146; no. Suppl_1
• Main Authors: Effron, Mark B, Kakkar, Anjali, Desrosiers, Greg, Velasco-Gonzalez, Cruz, Cooper-dehoff, Rhonda M
• Format: Journal Article
• Language: English
• Published: 08.11.2022
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.146.suppl_1.14224

Abstract only Introduction: Statins are the cornerstone therapy to lower low density lipoprotein cholesterol (LDL) but not all patients (pts) tolerate statins or reach LDL goal reduction with statin therapy. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) potently reduce LDL and demonstrate reduction of cardiovascular (CV) events compared to placebo. Despite this, prescribing rates of PCSK9i are low. Hypothesis: This study aims to identify patient factors associated with PCSK9i prescriptions. Methods: Pts with a prior CV event or diabetes with LDL >70 mg/dL on maximally tolerated statins or statin intolerant were identified using PCORnet clinical data marts (CDM) from REACHnet and OneFlorida. Pt demographics, co-morbidities, CV risk factors, 10-year ASCVD risk, and non-lipid lowering and lipid lowering drugs were provided in aggregate by the CDM. Categorical Baseline demographic and clinical characteristics differences were assessed by exact χ-square tests for categorical variables and Welsh t-tests for continuous variables. Unadjusted odds ratios (95% confidence intervals) were calculated to determine significance of the association. Results: Out of 464,664 pts, 0.3% received PCSK9i. Blacks had 21% lower odds of being prescribed PCSK9i as compared to whites. Non-Hispanics had 130% higher odds of being prescribed PCSK9i compared to Hispanics. Medicare pts had 44% higher odds of being prescribed PCSK9i than those with commercial insurance (Table). The presence of certain cardiac risk factors, such as MI and peripheral vascular disease, showed higher rates of PCSK9i prescription. Diabetes without known CV disease had the lowest odds of being prescribed PCSK9i. Conclusions: PCSK9i were rarely used. Higher CV risk appears to be a driver for use while it appears there is a bias in use based on race and ethnicity. Further analysis is needed to determine the interrelation of factors that limit prescription of PCSK9i and developing strategies to overcome them.