Lipidmanagement in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry

• Type of Material: Article
• Authors: Ann Marie Navar, Duke Clinical Research Institute; Tracy Y. Wang, Duke Clinical Research Institute; Shuang Li, Duke Clinical Research Institute; Jennifer G. Robinson, University of Iowa; Anne C. Goldberg, Washington University; Salim Virani, VA Medical Center; Veronique L. Roger, Mayo Clinic; Peter Wilson, Emory University; Joseph Elassal, Regeneron Pharmaceuticals Inc.; L. Veronica Lee, Sanofi Pharmaceuticals; Eric D. Peterson, Duke Clinical Research Institute
• Language: English
• Date: 2017-11-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ahj.2017.08.005
• Title of Journal or Parent Work: American Heart Journal
• ISSN: 0002-8703
• Volume: 193
• Start Page: 84
• End Page: 92
• Grant/Funding Information: This study was supported by Sanofi Pharmaceuticals and Regeneron Pharmaceuticals. Dr. Navar is supported by the NHLBI (K01HL133416-01).
• Keywords: THERAPY; Science & Technology; Cardiac & Cardiovascular Systems; GUIDELINE; Cardiovascular System & Cardiology; Life Sciences & Biomedicine; DISEASE; ATORVASTATIN
• Research Categories: Health Sciences, General

Abstract

Background The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDL-C) targets toward statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk. Methods Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary prevention patients from 138 PALM Registry practices. Results Overall, 74.7% of eligible adults were on statins; only 42.4% were on guideline-recommended intensity. Relative to primary prevention patients, ASCVD patients were more likely to be on a statin (83.6% vs 63.4%, P <.0001) and guideline-recommended intensity (47.3% vs 36.0%, P <.0001). Men were more likely than women to be prescribed recommended intensity for primary (odds ratio [OR] 1.87, 95% CI 1.49-2.34) and secondary (OR 1.47, 95% CI 1.26-1.70) prevention. In primary prevention, increasing age, diabetes, obesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients (OR 1.71, 95% CI 1.41-2.09), as were those seen by cardiologists (OR 1.43, 95% CI 1.12-1.83). Median LDL-C levels were highest among patients not on statins (124.0 mg/dL) and slightly higher among those on lower-than-recommended intensity compared with recommended-therapy recipients (88.0 and 84.0 mg/dL, respectively; P ≤.0001). Conclusions In routine contemporary practice, 1 in 4 guideline-eligible patients was not on a statin; less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment.