Statins Underutilized in Managing LDL-C in ASCVD

Individuals who have or are at risk for atherosclerotic cardiovascular disease (ASCVD) are being undertreated, according to new research.¹ Authors of a new retrospective study determined that many individuals with ASCVD are not utilizing pharmacotherapy, and many of those who are taking therapy are not meeting their recommended low-density lipoprotein cholesterol (LDL-C) level.²

“Increasing uptake of statins could drastically reduce the number of heart attacks, strokes, and death in patients with established vascular disease,” said study co-investigator Todd Anderson, MD, from the University of Calgary, in a press release.²

To assess the management of LDL-C with lipid-lowering therapy among individuals with ASCVD, the researchers identified 281,665 patients who had been diagnosed with the disease in Alberta, Canada, between 2011 and 2015. By linking multiple health system databases, the researchers examined clinical characteristics, treatments, and LDL-C assessments.

The researchers analyzed LDL-C by reviewing the 2 measurements that had been gathered during the study period: an index test as the first measurement and then a follow-up. 

Of those identified for the study, 219,488 participants had an index LDL-C test. In all, 120,906 participants received lipid-lowering therapy before their index test, and 144,607 received lipid-lowering therapy after their index test. A majority of the participants who were prescribed such medication were prescribed statins of moderate-intensity (33.5%) or high-intensity (27.2%).

Of those who had an index test, 91,841 also underwent a follow-up test. At the index test, 48.5% who received any lipid-lowering therapy did not meet the LDL-C level of less than 2.0 mmol/L recommended in the 2016 Canadian Cardiovascular Society guidelines. At the follow-up test, 36.6% did not meet the recommended LDL-C level or achieve a 50% reduction.

“The current study revealed that only two-thirds of patients with ASCVD were receiving pharmacotherapy and, of those, a significant proportion did not reach recommended LDL-C levels,” the authors concluded. “A remarkable treatment gap was identified for at-risk ASCVD patients. Further implementation strategies are required to address this undermanagement.”¹

—Colleen Murphy

References:

1. Chen G, Farris MS, Cowling T, et al. Treatment and low-density lipoprotein cholesterol management in patients diagnosed with clinical atherosclerotic cardiovascular disease in Alberta. Can J Cardiol. 2019;35(7):884-891. https://doi.org/10.1016/j.cjca.2019.04.008.

2. Cholesterol-lowering drugs are under-prescribed for prevention of atherosclerotic cardiovascular disease [press release]. Philadelphia, PA: Elsevier; July 15, 2019. https://www.elsevier.com/about/press-releases/research-and-journals/cholesterol-lowering-drugs-are-under-prescribed-for-prevention-of-atherosclerotic-cardiovascular-disease. Accessed July 15, 2019.