Statin Underuse and Low Prevalence of LDL-C Control Among U.S. Adults at High Risk of Coronary Heart Disease
Open accessAbstract
Background Statins reduce the risk of coronary heart disease (CHD) in individuals with a history of CHD or risk equivalents. A 10-year CHD risk >20% is considered a risk equivalent but is frequently not detected. Statin use and low-density lipoprotein cholesterol (LDL-C) control were examined among participants with CHD or risk equivalents in the nationwide Reasons for Geographic and Racial Differences in Stroke study (n = 8812). Methods Participants were categorized into 4 mutually exclusive groups: (1) history of CHD (n = 4025); (2) no history of CHD but with a history of stroke and/or abdominal aortic aneurysm (AAA) (n = 946); (3) no history of CHD or stroke/AAA but with diabetes mellitus (n = 3134); or (4) no history of the conditions in (1) through (3) but with 10-year Framingham CHD risk score (FRS) >20% calculated using the third Adult Treatment Panel point scoring system (n = 707). Results Statins were used by 58.4% of those in the CHD group and 41.7%, 40.4% and 20.1% of those in the stroke/AAA, diabetes mellitus and FRS >20% groups, respectively. Among those taking statins, 65.1% had LDL-C <100 mg/dL, with no difference between the CHD, stroke/AAA, or diabetes mellitus groups. However, compared with those in the CHD group, LDL-C <100 mg/dL was less common among participants in the FRS >20% group (multivariable adjusted prevalence ratio: 0.72; 95% confidence interval: 0.62-0.85). Results were similar using the 2013 American College of Cardiology/American Heart Association cholesterol treatment guideline. Conclusions These data suggest that many people with high CHD risk, especially those with an FRS >20%, do not receive guideline-concordant lipid-lowering therapy and do not achieve an LDL-C <100 mg/dL.
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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 [9]
The Discussion reports that only one in five participants with FRS >20% and no history of CHD, stroke, AAA, or diabetes was taking a statin, supporting underuse in high-risk primary prevention. It also identifies being a woman or Black as associated with not taking statins among high-risk participants overall, but does not establish those associations specifically in the primary-prevention subgroup or for racial and ethnic minority populations broadly. No page numbers are available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMore than half of eligible patients do not currently receive lipid-lowering therapies.
“More than half of eligible patients do not currently receive lipid-lowering therapies.9”
From Bempedoic Acid for Primary Prevention of Cardiovascular Events in Statin-Intolerant Patients (2023) · cites this paper as [9]
The Discussion reports that fewer than half of the U.S. adults studied who were at high risk for coronary heart disease were taking statins. The study measured statin use, not use of all lipid-lowering therapies, and its finding is limited to that high-risk population rather than all eligible patients. (LLM, conf=0.85)
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 [9]
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Serban, M.-C., Colantonio, L. D., Manthripragada, A. D., Monda, K. L., Bittner, V. A., Banach, M., Chen, L., Huang, L., Dent, R., Kent, S. T., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2016.12.036 · Cited by 318 · see citing works
Self-citationStatin non-adherence and residual cardiovascular risk: There is need for substantial improvement
Banach, M., Stulc, T., Dent, R., & Toth, P. P. (2016) · International Journal of Cardiology · doi:10.1016/j.ijcard.2016.09.075 · Cited by 197 · see citing works
Bempedoic 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
Hobbs, F. R., Banach, M., Mikhailidis, D. P., Malhotra, A., & Capewell, S. (2016) · BMC Medicine · doi:10.1186/s12916-016-0550-5 · Cited by 76 · see citing works
Schleyer, T., Hui, S., Wang, J., Zhang, Z., Knapp, K., Baker, J., Chase, M., Boggs, R., & Simpson, R. J. (2019) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2019.25.5.544 · Cited by 19 · see citing works
- Authors
- Gamboa, C. M., Safford, M. M., Levitan, E. B., Mann, D. M., Yun, H., Glasser, S. P., Woolley, J. M., Robert, R., Farkouh, M., & Muntner, P.
- Affiliations
- Boston University (US)
- University of Alabama at Birmingham (US)
- Amgen (United States) (US)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Muntner, Paul
- ORCID
- Venue
- The American Journal of the Medical Sciences
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 348
- Issue
- 2
- Pages
- 108-114
- ISSN
- 0002-9629 (ISSN-L)
- PMC
- PMC4108514
- OpenAlex
- W2046039931
- Cited by
- 50
- References
- 1
- Citations by year
- 2025: 3 · 2024: 4 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 3 · 2018: 3 · 2017: 7 · 2016: 8 · 2015: 6 · 2014: 2
- FWCI
- 7.20
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The American Journal of the Medical Sciences (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (K12HS021694)
- National Heart, Lung, and Blood Institute (R01HL080477, K24HL111154)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK079626)
- National Institute of Neurological Disorders and Stroke (U01NS041588, R01NS041588)
- National Institute on Minority Health and Health Disparities (P20MD006899)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- LDL cholesterol control, coronary artery disease, high cardiovascular risk, Framingham risk score, lipid-lowering therapy, guideline-concordant care, stroke, abdominal aortic aneurysm, diabetes mellitus
- MeSH terms
- Aged, Coronary Disease, Female, Humans, Cholesterol, LDL, Male, Models, Theoretical, Risk Factors, United States, Prevalence, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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