Practice-level adherence to statin use guidelines and control of low-density lipoprotein cholesterol (LDL-C) in patients vary widely between clinics in the United States, according to study results presented at the American College of Cardiology Annual Scientific Session held March 16 to 18, 2019, in New Orleans, Louisiana.
Statin adherence in the United States is suboptimal. To better understand how compliance to statin recommendations varies across practices, researchers examined data from the Patient and Provider Assessment of Lipid Management registry. Using multivariable linear modeling, US clinics enrolling ≥20 patients with or at elevated risk for atherosclerotic cardiovascular disease were compared according to the American College of Cardiology/American Heart Association 2013 guidelines for statin use. LDL-C control (<100 mg/dL or <70 mg/dL) was assessed on the basis of the percentage of eligible patients receiving guideline-recommended statin treatment.
In total, 5445 patients were enrolled in 74 practices (43% cardiology, 47% primary care), and 56% had atherosclerotic cardiovascular disease. Recommended statin use varied widely between clinics, even when participants were stratified as primary vs secondary prevention patients. Clinics offering treatment to >48% of appropriate patients were in the top tertile of clinics for guideline-recommended statin use; compared with clinics in the middle and low tertiles, top-tertile clinics were more often cardiology practices (68% vs 48% vs 13%; P <.001) and treated more patients with atherosclerotic cardiovascular disease (71% vs 56% vs 43%; P <.001).
Patients treated at clinics in the top tertile were more likely to achieve LDL-C <70 mg/dL (adjusted odds ratio, 1.49; 95% CI, 1.08-2.04) and <100 mg/dL (adjusted odds ratio, 1.79; 95% CI, 1.42-2.26) compared with patients at low-tertile clinics.
Overall, the results indicate that the percentage of patients receiving guideline-recommended statin therapy is highly varied among US clinics. Patients receiving care at practices that offer statins to more eligible patients are more likely to achieve control of LDL-C.
Nanna M, Navar AM, Wang T, et al. Practice-level variation in statin use and LDL-C control in the United States: results from the Patient and Provider Assessment of Lipid Management (PALM) registry. Presented at: American College of Cardiology 68th Annual Scientific Session; March 16-18, 2019; New Orleans, LA. Abstract 1033-03.