Do All Statin Users Reach Healthy LDL-C Levels?

New research suggests approximately one-third of individuals treated with statins do not achieve appropriate thresholds of low-density lipoprotein cholesterol (LDL-C)—a key predictor of residual cardiovascular disease (CVD) event risk.

In a retrospective, longitudinal cohort study of patients from Indiana, 30,083 (33.7%) of 89,267 patients (general cohort) who had initiated statins between 2012 and 2016 did not meet an LDL-C threshold of less than 100 mg/dL after 6 to 18 months of therapy. In a high-risk subgroup, 58.1% of statin-treated patients did not meet a threshold of less than 70 mg/dL.

Individuals who did not achieve healthy LDL-C levels were most often women, black, and/or had poor adherence to therapy. However, even among those who had adhered to therapy, 23.7% of patients in the general cohort and 50.5% of patients in the high-risk subgroup did not meet appropriate LDL-C thresholds, the researchers noted.

Patients who achieved healthy LDL-C levels often had higher levels of preventive aspirin use and antihypertensive treatment.

“The proportions of patients not achieving threshold LDL-C levels indicate an unmet preventive need,” the researchers wrote. “The size of these patient populations, the unmet need for prevention and treatment, and the resulting health care burden are of keen interest to health care organizations, clinicians, payers, and public health agencies.”

Patients included in the study had met the following criteria:

• Had been older than age 45 years during the study period.
• Had been seen in a clinical setting between January 1, 2012, and October 31, 2016.
• Had been statin-naïve for 12 months prior to initiating statin therapy.
• Had an LDL-C value recorded 6 to 18 months after initiating statin therapy.

Data for the study were obtained from electronic health records in the Indiana Network for Patient Care. Framingham Risk Score and Cholesterol Treatment Trialists’ Collaboration formulas were used to determine the theoretical CVD risk reduction patients could achieve by reaching appropriate LDL-C thresholds.

After calculating these scores, the researchers found that, “achieving therapeutic thresholds would have reduced relative risk by 14.8% and avoided $1455 per patient in CVD event treatment costs for the general cohort (15.7% and $1902, respectively, for the secondary prevention cohort) over a 10-year period.”

—Christina Vogt

Reference:

Schleyer T, Hui S, Wang J, et al. Quantifying unmet need in statin-treated hyperlipidemia patients and the potential benefit of further LDL-C reduction through an EHR-based retrospective cohort study. J Manag Care Spec Pharm. 2019;25(5):544-554. https://doi.org/10.18553/jmcp.2019.25.5.544.