Patterns and predictors of lipid‐lowering therapy in patients with atherosclerotic cardiovascular disease and/or diabetes mellitus in 2014: Insights from a large US managed‐care population

Abstract

Background: Lowering low-density lipoprotein cholesterol with statins reduces risk of cardiovascular events. We examined patterns and predictors of filled prescriptions for lipid-lowering therapy (LLT) in subgroups of patients with atherosclerotic cardiovascular disease (ASCVD) and/or diabetes mellitus (DM). Hypothesis: Statin treatment remains underutilized across subgroups of high CV risk patients.Methods: Patients in the Optum Research Database with these criteria were included: age ≥20 years, 2 years continuous enrollment, and ASCVD and/or DM. Patients were hierarchically classified by the presence of recent acute coronary syndrome, other coronary heart disease, ischemic stroke, peripheral arterial disease (PAD), or only DM. Predictors of filled LLT regimens were examined using multinomial logistic regression.Results: A total of 1 055 932 individuals met all inclusion criteria. Evidence by point-in-time analysis of filled (not only written) statin prescriptions was 45% for the overall cohort. By subgroups, this was 62%, 52%, 43%, 36%, and 40% for recent acute coronary syndrome, other coronary heart disease, ischemic stroke, PAD, and only DM, respectively. Predictors of higher rates of any statin regimen included age 50 to 69 years, male sex, absence of comorbidities, and filled prescriptions of other standard-of-care therapies. Conclusions:In 2014, only 49% of patients with ASCVD and 40% with only DM had evidence for a filled statin prescription. Those with indications of ischemic stroke, PAD, and DM were less likely to receive statins than those with coronary conditions. Other characteristics such as advanced age, female sex, and noncardiac conditions predicted less statin utilization, thereby representing good targets for quality improvement. comprehensive analysis of the predictors and actual filled prescription patterns of statin and nonstatin lipid-lowering therapies (LLT) in subgroups of ASCVD and diabetes mellitus (DM) patients collected from a contemporary, generalizable database of US patients. | METHODSThis was a retrospective, cross-sectional, observational study. Data were de-identified in accordance with established privacy guidelines under the Health Insurance Portability and Accountability Act; therefore, separate institutional review board approval was not sought. | Database and cohort selectionWe utilized high-CV-risk condition(s) using 2 methods. In the first method, each patient was classified hierarchically into the highest mutually exclusive CV-risk condition (using the order above) for which he/she qualified (termed "hierarchical" subgroups). In the second method, each patient was classified into each CV-risk condition for which he/she qualified (termed "prevalent" subgroups); thus, a patient could be included in ≥1 CV condition under prevalent categorization. As an example, an individual with a history of elective coronary revascularization and DM would be hierarchically classified as "other CHD," but as both "other CHD" and "DM" by prevalent classification. International Classific...

Guideline‐directed statin intensification in patients with new or worsening symptoms of peripheral artery disease

“…Our At the patient level, differences in clinical and socio-demographic characteristics before and after specialist evaluation were similar. In line with prior work, 26,27 participants with a history of cardiovascular disease and risk factors were more likely to be appropriately treated with statin therapy. Among those eligible to receive statin intensification, patients that were older were less likely to be appropriately treated, and those with typical symptoms were more likely.…”

Design and rationale of the EBBINGHAUS trial: A phase 3, double‐blind, placebo‐controlled, multicenter study to assess the effect of evolocumab on cognitive function in patients with clinically evident cardiovascular disease and receiving statin background lipid‐lowering therapy—A cognitive study of patients enrolled in the FOURIER trial

“…Thus, there is an unmet need for a potent, effective nonstatin agent that will permit a significantly greater proportion of patients to achieve lower LDL‐C concentrations and further reduce cardiovascular risk . Based on current data, evolocumab may fulfill this need and provide an important addition to the treatment of hypercholesterolemia, particularly for high‐risk patients with a history of cardiovascular disease.…”

“…1 Furthermore, data continue to accrue that even among patients who achieve low low-density lipoprotein cholesterol (LDL-C) levels (ie, <70 mg/dL), cardiovascular events may be reduced even further with additional reduction in LDL-C. 1,2 Thus, there is an unmet need for a potent, effective nonstatin agent that will permit a significantly greater proportion of patients to achieve lower LDL-C concentrations and further reduce cardiovascular risk. 3,4 Based on current data, evolocumab may fulfill this need and provide an important addition to the treatment of hypercholesterolemia, particularly for high-risk patients with a history of cardiovascular disease.…”

Periphere arterielle Verschlusskrankheit: Wann ist ein PCSK9-Inhibitor sinnvoll?

“…[21] Trotz dieser eindeutigen Empfehlung erhalten längst nicht alle Patienten mit einer PAVK eine lipidsenkende Therapie. Eine Analyse der Optum-Research-Datenbank (n = 1 055 932 Personen) in den USA ergab, dass zwar 62 % der Patienten mit einem akuten Koronarsyndrom und 52 % aller Patienten mit einer KHK, aber nur 36 % aller Patienten mit einer PAVK eine lipidsenkende Therapie erhielten [24]. Jahre.…”