Impact of the 2013 Cholesterol Guideline on Patterns of Lipid-Lowering Treatment in Patients with Atherosclerotic Cardiovascular Disease or Diabetes After 1 Year

Abstract

No outside funding supported this research. Chan is supported by grants from the National Heart Lung and Blood Institute (1R01HL123980 and K23HL102224). Tran, Stockl, Lew, and Solow are employed by Optum. Kao and Caglar were employed by Optum when this study was conducted. Chan serves as an advisor and consultant to OptumRx but received no compensation for work on this manuscript. Stockl is also employed by the Journal of Managed Care & Specialty Pharmacy. Spertus reports personal fees from United Healthcare and grants from Lilly, outside of the submitted work. None of the authors have any other financial conflicts of interest to report. Tran and Chan supervised this study, had full access to all of the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. Study design and concept were contributed by Tran and Chan. Tran and Kao collected the data, with analysis and interpretation performed by all the authors. Statistical analysis was performed by Caglar and Kao, and Tran and Chan drafted the manuscript. All authors were involved in the critical revision of the manuscript.

Effects of Guideline and Formulary Changes on Statin Prescribing in the Veterans Affairs

“…The modest effect of the ACC/AHA guideline change on statin prescribing we observed is consistent with some recent reports that the ACC/AHA guideline change was associated with either a negligible (Tran et al. ) or small (Rodriguez et al. ; Pokharel et al.…”

“…Similarly, the large decline in use of simvastatin during the preformulary period, though not a central focus of our analysis, is temporally associated with the FDA's June 2011 "black box" warning regarding use of high-dose simvastatin (Food and Drug Administration 2011), a finding consistent with some studies of previous drug-specific FDA regulatory warnings (Dorsey et al 2010;Dusetzina et al 2012). The modest effect of the ACC/AHA guideline change on statin prescribing we observed is consistent with some recent reports that the ACC/AHA guideline change was associated with either a negligible (Tran et al 2016) or small Pokharel et al 2017) change in the use of statins and nonstatin lipid-lowering drugs. A study in the VA found somewhat larger changes in statin use but did not include all high-risk patients, was limited to 6 months of postguideline data, and did not adjust for underlying trends in statin use .…”

Adherence to Blood Cholesterol Treatment Guidelines Among Physicians Managing Patients With Atherosclerotic Cardiovascular Disease

“…This rate of adherence to guidelines is in-line or slightly above previously published estimates of statin use in nationally representative managed care populations. 5,9 Our chart review analysis builds on previous publications that rely on physician surveys to understand observed statin treatment patterns. 10,11 By evaluating the reasons behind therapeutic decisions documented in the notes of the prescribing physician, which is not typically available through traditional database analyses, our study provides essential information needed to better understand statin prescribing patterns.…”

Effect of 2013 ACC/AHA Blood Cholesterol Guidelines on Statin Treatment Patterns and Low‐Density Lipoprotein Cholesterol in Atherosclerotic Cardiovascular Disease Patients

“…At the time the guidelines were published, projections indicated that they would greatly expand the pool of patients who qualify for statin therapy, thereby increasing the use of statins 8, 10. We examined over 90 000 patients before and after the guidelines release and found that overall statin use decreased following the release of the guidelines.…”