May 21, 2014
Over-Emphasis on Hyperlipidemia Keeps Statin Use Too Low

Columbus, OH—Statins remain significantly underused in Americans from 30 to 79 years old who have high cardiovascular disease risk, primarily because too much emphasis is placed on using the therapy for hyperlipidemia and not enough on other benefits, according to a new study.

The study, published recently in Annals of Family Medicine, finds that an estimated 9.0 million adults 40 or older with diabetes and 5.6 million coronary artery disease patients were not on statins.

“The identified populations have clearly been shown to benefit from statins. People with coronary artery disease have an approximate 16% reduction in overall mortality, while people aged older than 40 years with diabetes have a more than 30% reduction in cardiovascular disease outcomes and likely a reduced risk of death. Importantly, statins have benefit irrespective of cholesterol levels,” write the authors from the University of Ohio in Columbus and the University of Michigan in Ann Arbor.

The study used nationally representative data with 16,712 participants aged 30 to 79—the 2010 Medical Expenditure Panel Survey—to examine the relationships between statin use and cardiovascular risk, diagnosis of hyperlipidemia, and other risk factors.

Results indicate that, overall, 58.2% of patients with coronary artery disease and 52.0% of patients 40 years and older with diabetes were statin users. After adjusting for cardiovascular risk factors and sociodemographic factors, researchers report that the probability of being on a statin was significantly higher among individuals with both hyperlipidemia and coronary artery disease, at 0.44 (95% CI, 0.40-0.48), or hyperlipidemia only, at 0.32 (95% CI, 0.30-0.33), than among those with coronary artery disease only, at 0.11 (95% CI, 0.07-0.15), adding that a similar pattern was seen in people with diabetes.

“In this nationally representative sample, many people at high risk for cardiovascular events, including those with coronary artery disease, diabetes, or both, were not receiving statins despite evidence that these agents reduce adverse events,” according to the authors.

“Despite this benefit, hyperlipidemia appears to be the driving force behind statin use in both primary and secondary prevention,” they emphasize. “For years, guidelines, general public health messages, and direct-to-consumer advertising have anchored statins to cholesterol reduction rather than cardiovascular risk reduction. Given the substantial under-treatment of high-risk groups in our analysis, focusing resources on improving rates of use among those at high risk would likely have a greater impact in terms of morbidity and mortality than simply expanding use. This impact is especially true among individuals with coronary artery disease or with diabetes and age older than 40 years and likely among those with cerebrovascular disease and peripheral arterial disease.”

The study notes that recently released guidelines from the American College of Cardiology and the American Heart Association offer an opportunity to improve statin use by focusing on cardiovascular risk instead of lipid levels.

U.S. Pharmacist Social Connect