Lipid management in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry
Open accessAbstract
Background The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDL-C) targets toward statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk. Methods Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary prevention patients from 138 PALM Registry practices. Results Overall, 74.7% of eligible adults were on statins; only 42.4% were on guideline-recommended intensity. Relative to primary prevention patients, ASCVD patients were more likely to be on a statin (83.6% vs 63.4%, P<.0001) and guideline-recommended intensity (47.3% vs 36.0%, P<.0001). Men were more likely than women to be prescribed recommended intensity for primary (odds ratio [OR] 1.87, 95% CI 1.49-2.34) and secondary (OR 1.47, 95% CI 1.26-1.70) prevention. In primary prevention, increasing age, diabetes, obesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients (OR 1.71, 95% CI 1.41-2.09), as were those seen by cardiologists (OR 1.43, 95% CI 1.12-1.83). Median LDL-C levels were highest among patients not on statins (124.0 mg/dL) and slightly higher among those on lower-than-recommended intensity compared with recommended-therapy recipients (88.0 and 84.0 mg/dL, respectively; P≤.0001). Conclusions In routine contemporary practice, 1 in 4 guideline-eligible patients was not on a statin; less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment.
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Currently, lipid-lowering therapies are underutilized in high-risk primary prevention patients, particularly women and patients from racial and ethnic minority populations.
“Currently, lipid-lowering therapies are underutilized in high-risk primary prevention patients, particularly women and patients from racial and ethnic minority populations.[8][9][10]”
From Bempedoic Acid for Primary Prevention of Cardiovascular Events in Statin-Intolerant Patients (2023) · cites this paper as [8]
The Results (page unavailable) report that only 36.0% of eligible primary-prevention patients received guideline-recommended statin intensity, and the Discussion (page unavailable) says women were less likely than men to receive it. The passages do not establish that patients from racial or ethnic minority populations were particularly undertreated; they also concern statins rather than lipid-lowering therapies generally. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThese findings emphasize the potential value of lipid-modulating therapy in patients who have had no prior cardiovascular event but who have a high risk for a first event, a population that is currently undertreated.
“These findings emphasize the potential value of lipidmodulating therapy in patients who have had no prior cardiovascular event but who have a high risk for a first event, a population that is currently undertreated.[8][9][10][15][16][17][18]”
From Bempedoic Acid for Primary Prevention of Cardiovascular Events in Statin-Intolerant Patients (2023) · cites this paper as [8]
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Cites
Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein
Ridker, P. M., Danielson, E., Fonseca, F. A. H., Genest, J., Gotto, A. M., Kastelein, J. J. P., Koenig, W., Libby, P., Lorenzatti, A. J., MacFadyen, J. G., et al. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa0807646 · Cited by 6,674 · see citing works
2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk
Goff, D. C., Lloyd-Jones, D. M., Bennett, G., Coady, S., D’Agostino, R. B., Gibbons, R., Greenland, P., Lackland, D. T., Levy, D., O’Donnell, C. J., et al. (2014) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2013.11.005 · Cited by 4,945 · see citing works
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Research works printed but not linked: 12
- [1]Stone NJ Robinson JG Lichtenstein AH 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Circulation 2014 129 S1 45 24222016
- [2]National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report Circulation 2002 106 3143 421 12485966
- [4]Cannon CP Braunwald E McCabe CH Intensive versus moderate lipid lowering with statins after acute coronary syndromes N Engl J Med 2004 350 1495 504 15007110
- [5]LaRosa JC Grundy SM Waters DD Intensive lipid lowering with atorvastatin in patients with stable coronary disease N Engl J Med 2005 352 1425 35 15755765
- [6]Pedersen TR Faergeman O Kastelein JJ High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial JAMA 2005 294 2437 45 16287954
- [7]Pencina MJ Navar-Boggan AM D’Agostino RB Sr Application of new cholesterol guidelines to a population-based sample N Engl J Med 2014 370 1422 31 24645848
- [8]Bellows BK Olsen CJ Voelker J Antihyperlipidemic medication treatment patterns and statin adherence among patients with ASCVD in a managed care plan after release of the 2013 ACC/AHA guideline on the treatment of blood cholesterol J Manag Care Spec Pharm 2016 22 892 900 27459651 PMC10397611
- [9]Navar AM Wang TY Goldberg AC Design and rationale for the Patient and Provider Assessment of Lipid Management (PALM) registry Am Heart J 2015 170 865 71 26542493
- [11]Gu Q Paulose-Ram R Burt VL Prescription cholesterol lowering medication use in adults aged 40 and over: United States, 2003–2012 NCHS data brief, No. 177 Centers for Disease Control and Prevention web site. http://www.cdc.gov/nchs/data/databriefs/db177.pdf. Published December 2014. Accessed November 21, 2016 25536410
- [12]Virani SS Woodard LD Ramsey DJ Gender disparities in evidence-based statin therapy in patients with cardiovascular disease Am J Cardiol 2015 115 21 6 25456865
- [13][No authors listed] Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II) JAMA 1993 269 3015 23 8501844
- [14]Hira RS Cowart JB Akeroyd JM Risk factor optimization and guideline-directed medical therapy in us veterans with peripheral arterial and ischemic cerebrovascular disease compared to veterans with coronary heart disease Am J Cardiol 2016 118 1144 9 27553104
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Bradley, C. K., Wang, T. Y., Li, S., Robinson, J. G., Roger, V. L., Goldberg, A. C., Virani, S. S., Louie, M. J., Lee, L. V., Peterson, E. D., et al. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.118.011765 · Cited by 286 · see citing works
Self-citationBempedoic Acid for Primary Prevention of Cardiovascular Events in Statin-Intolerant Patients
Nissen, S. E., Menon, V., Nicholls, S. J., Brennan, D., Laffin, L., Ridker, P., Ray, K. K., Mason, D., Kastelein, J. J. P., Cho, L., et al. (2023) · JAMA · doi:10.1001/jama.2023.9696 · Cited by 146 · see citing works
Nanna, M. G., Navar, A. M., Zakroysky, P., Xiang, Q., Goldberg, A. C., Robinson, J., Roger, V. L., Virani, S. S., Wilson, P. W. F., Elassal, J., et al. (2018) · JAMA Cardiology · doi:10.1001/jamacardio.2018.1511 · Cited by 122 · see citing works
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Koren, M. J., Rodriguez, F., East, C., Toth, P. P., Watwe, V., Abbas, C. A., Sarwat, S., Kleeman, K., Kumar, B., Ali, Y., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2024.03.382 · Cited by 81 · see citing works
- Authors
- Navar, A. M., Wang, T. Y., Li, S., Robinson, J. G., Goldberg, A. C., Virani, S., Roger, V. L., Wilson, P. W. F., Elassal, J., Lee, L. V., & Peterson, E. D.
- Affiliations
- Duke Clinical Research Institute (US)
- University of Iowa (US)
- Washington University in St. Louis (US)
- Baylor College of Medicine (US)
- Mayo Clinic (US)
- Emory University (US)
- Regeneron (United States) (US)
- Sanofi (United States) (US)
- ORCID
- Venue
- American Heart Journal
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 193
- Pages
- 84-92
- ISSN
- 0002-8703 (ISSN-L)
- PMC
- PMC5714300
- OpenAlex
- W2744913278
- Cited by
- 94
- References
- 2
- Citations by year
- 2026: 11 · 2025: 12 · 2024: 12 · 2023: 15 · 2022: 11 · 2021: 9 · 2020: 7 · 2019: 14 · 2018: 3
- FWCI
- 6.73
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- American Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion)
- Funders
- Sanofi Pharmaceuticals
- Regeneron Pharmaceuticals
- National Heart, Lung, and Blood Institute (K01HL133416-01)
- National Institutes of Health (K01HL133416-01)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Keywords
- lipid control, statin therapy, statin intensity, LDL cholesterol, atherosclerotic cardiovascular disease risk, primary prevention, secondary prevention, undertreatment, sex differences, coronary artery disease, cholesterol guidelines, community practice
- MeSH terms
- Aged, Female, Follow-Up Studies, Humans, Lipids, Male, Primary Health Care, Primary Prevention, Registries, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Disease Management, Atherosclerosis, Secondary Prevention
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