Abstract 13945: LDL-C Values and Lipid Lowering Therapy Utilization Among Medicare Beneficiaries With a Recent Myocardial Infarction

• Published in: Circulation (New York, N.Y.) Vol. 140; no. Suppl_1 Suppl 1; p. A13945
• Main Authors: Desai, Nihar R, DiMario, Stefan, Schludi, Belinda, Habib, Mohdhar, Mues, Katie, Dietz, Kevin, Shen, Xian
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 19.11.2019
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.13945

IntroductionLDL-C is a causal risk factor for myocardial infarction (MI). The 2018 ACC/AHA Blood Cholesterol Guidelines classify recent (within 12 months) MI to be a major ASCVD event and part of the criteria to identify very high risk (VHR) patients for whom non-statin therapy may be indicated if LDL-C remains ≥70 mg/dL despite maximally tolerated statin.HypothesisTo assess LDL-C values and lipid lowering therapy (LLT) utilization in the Medicare fee-for-service population with a recent MI.MethodsThis was a retrospective cohort study using the 100% Medicare Parts A/B/D claims linked to the Prognos LDL-C database. Patients were included if they had an LDL-C value (index) in calendar year 2017 and an MI in the prior year. LLT utilization was assessed in the month prior to the LDL-C value.ResultsA total of 72,145 Medicare beneficiaries were included. Mean age was 73 years and 46% were female. The majority of patients had LDL-C values ≥70 mg/dL regardless of when the MI occurred. Depending on recency of MI, the percent of patients using high intensity statin therapy varied between 41% and 33%, and 23% to 27% of patients were not currently taking a statin or ezetimibe. Use of PCSK9i remained low across groups. The table below stratifies results by the timing of a patient’s MI within the prior 12 months.ConclusionThe majority of Medicare beneficiaries with a recent MI had LDL-C values ≥70 mg/dL. There is substantial underuse of high-intensity statin therapy and there are many patients for whom non-statin therapy may be indicated to address residual risk. Patients whose MI occurred less recently had higher LDL-C values and were treated less aggressively. Patients with a recent MI remain at risk of subsequent events and more urgency is needed to intensify treatment and control LDL-C.