Suboptimal adherence to and low prescribing of high-intensity statin therapy may be associated with the modest reductions in low-density lipoprotein cholesterol (LDL-C) observed in patients with atherosclerotic cardiovascular disease (ASCVD), according to a study published in the Journal of Clinical Lipidology.

In this retrospective study, the electronic health records from a community-based healthcare system in California of 6199 patients with ASCVD (ages, ≥21 years; mean age, 67.1 years) who received a new statin prescription between 2002 and 2016, were examined. Changes in LDL-C were the study’s primary outcome. Additional outcomes were the prescribing rates of high-intensity statin therapy at treatment initiation, statin therapy titrations rates, and medication adherence (ie, proportion of days covered; cut-off, ≥0.80).

A total of 16.6% of patients received a high-intensity statin therapy prescription at treatment initiation, and 53% were adherent to statins. During a mean follow-up period of 16.8 months, the mean change in LDL-C was–35.2 mg/dL (25% reduction), with 17.7% of patients experiencing a >50% reduction in LDL-C. Reductions in LDL-C were highest in patients who initiated high-intensity statin therapy (30.0%) compared with moderate-intensity statin therapy (18.8%), and low-intensity statin therapy (6.5%).

The rates of statin intensity-level increases and decreases were 8.4 and 7.6 per person-years, respectively. Prescribing rates for high-intensity statin therapy increased over time. Independent predictors for achieving LDL-C <70 mg/dL or LDL-C <100 mg/dL included initiation on high-intensity statin therapy, higher statin adherence, and treatment intensification during the follow-up period.


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Limitations of the study include its observational and retrospective design as well as the relatively short duration follow-up, which the researchers suggested was not sufficient to identify long-term outcomes in this patient population.

“Clinician and patient education are needed to reduce clinical inertia and improve medication adherence to better manage ASCVD,” concluded the study authors.

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Disclosure: This clinical trial was supported by Regeneron Pharmaceuticals and Sanofi. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Romanelli RJ, Ito MK, Karalis DG, et al. Statin utilization and low-density lipoprotein cholesterol in statin-treated patients with atherosclerotic cardiovascular disease: Trends from a community-based healthcare delivery system, 2002–2016 [published online April 10, 2020]. J Clin Lipidol. doi:10.1016/j.jacl.2020.03.006