Daily Dose: Eligible Adults Lack Statin Prevention for ASCVD

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in Annals of Internal Medicine that described trends in statin use for primary prevention across indication categories and atherosclerotic cardiovascular disease (ASCVD) risk scores.

The study

Investigators used National Health and Nutrition Examination Survey data from 1999 to 2018 to assess trends in statin use among nonpregnant adults aged ≥20 years who had no known ASCVD and provided fasting laboratory data. Participants were classified as previously, newly, or continuously eligible for statins if they met statin use criteria based only on the 2002 Adult Treatment Panel III guidelines, only the 2013 ACC/AHA guidelines, or both guidelines, respectively.

In total, 21 961 adults were included in the study, of whom 35.6% had an indication for statin use for primary prevention.

Findings

The proportion of guideline-eligible adults who reported receiving statins increased from 11.6% (95% CI, 7.7%-15.6%) in 1999-2000 to 33.6% (95% CI, 27.5%-39.6%) in 2013-2014, which is an increase of 22 percentage points (95% CI, 14.7-29.2), according to the results. Between 2013-2014 and 2017-2018, however, there was no significant change in statin use among eligible participants (change –1.2 percentage point, 95% CI –8.6 to 6.3 percentage points).

Moreover, among adults who were newly eligible to receive statins under the 2013 ACC/AHA guidelines, researchers reported no significant change in the proportion of statin users between 2013-2014 and 2017-2018 (change, –2.1 percentage points, 95% CI –15.1 to 11).

Authors' comment

“Most adults with guideline recommendations for primary prevention statins are not receiving them, including those with diabetes or a low-density lipoprotein cholesterol level above 4.92 mmol/L
(190 mg/dL), indicating that novel efforts, informed by implementation science and targeting patients with the greatest risk, are urgently needed."

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