Despite evidence and clinical guidelines that support intensive statin use in high-risk patients, very few eligible patients start treatment at recommended levels.
Both the American College of Cardiology (ACC) and American Heart Association (AHA) recommend the use of high-intensity statins in patients at highest risk for CV events. Clinical evidence shows that patients at high risk for cardiovascular (CV) events stand to gain the most from statins—especially intensive rather than standard dosing of statins.
Despite all this, a new study confirms that statin therapy remains widely underused in these high-risk patients. The large-scale, comprehensive study of statin use in a real-world population of patients at high risk for CV events was published in the June 2016 issue of Journal of Managed Care & Specialty Pharmacy,
Iris Lin, PhD, of Boston Healthcare Economics in Waltham, Massachusetts, and colleagues used the Truven MarketScan Commercial and Medicare Supplement database from January 2007 to June 2013, to identify over 541,000 adult patients at high CV risk who received one or more prescriptions for statin monotherapy and who had not received any lipid-reducing therapies for the past 12 months. The patients were divided into 5 mutually exclusive CV risk categories:
· recent CV event, which included hospitalization for acute coronary syndrome (ACS) or other non-ACS event within 90 days
· coronary heart disease (CHD)
· history of ischemic stroke
· peripheral artery disease (PAD)
Most patients were in the diabetes group (61.1%), followed by recent ACS event (15.8%), recent non-ACS event (9.9%), PAD (4.7%), CHD (4.4%), and history of ischemic stroke (4.1%).
The investigators kept track of changes in therapy, the proportion of days covered (PDC), which was the percentage of patients who filled at least 2 prescriptions for a statin or statin combination on 2 different dates; time to discontinuation of medication; and proportion of patients with atherosclerotic CV disease-related inpatient visits during the follow-up period. Statin therapy was divided into high-intensity treatment (atorvastatin 40 mg or 80, rosuvastatin 20 mg or 40 mg, or simvastatin 80 mg) or moderate- to low-intensity treatment (all other statins and statin dosing regimens).
The investigators found that only 15% of the patients started their therapy with a high-intensity statin, and 22.5% of these patients switched to a moderate- to low-intensity regimen during the follow-up period. The median time to discontinuing statin therapy was approximately 15 months. Treatment duration was longer among those who were treated with a high-intensity statin (21 months) than among those with moderate- to low-intensity statin (15 months) regimens.
Patients with recent ACS hospitalizations had a high 1-year risk of atherosclerotic CV disease (21.8%); among the patients with diabetes, the figure was lower (3.5%).
The investigators concluded that high-intensity statin therapy is infrequently prescribed to patients at high risk for CV events, regardless of the underlying risk factors. Adherence to statin therapy is less than optimal, with high discontinuation rates among all high CV-risk patient subgroups.
“The continued use of moderate- to low-intensity therapy, failure to intensify treatment, poor adherence, and high rates of discontinuation result in a large number of patients who are inadequately protected from recurrent CV events,” the researchers conclude. Health care system-based interventions and new therapeutic paradigms are needed to optimize patient care, manage risk, and enhance outcomes, they found.
The study was supported by Regeneron Pharmaceuticals and Sanofi US.
Lin I, Sung J, Sanchez RJ, et al. Patterns of statin use in a real-world population of patients at high cardiovascular risk. J Manag Care Spec Pharm. 2016;22(6):685-698.