U.S. statin use plateaued in 2013 to 2018
Most U.S. adults with the strongest guideline recommendations for primary prevention with statins are not receiving them, including those with diabetes, extremely high cholesterol levels, or 10-year risk of cardiovascular disease over 20%, a study found.
Use of statins for primary prevention increased over time but then plateaued from 2013 to 2018 at 35% percent of eligible adults, a study found.
Researchers examined statin use among nonpregnant adults ages 20 years or older who had no known atherosclerotic cardiovascular disease (ASCVD) and who provided data to the National Health and Nutrition Examination Survey from 1999 to 2018. Participants were defined as previously, newly, or continuously eligible for statins based on the 2002 Adult Treatment Panel III guidelines, the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, or both.
The study cohort included 21,961 adults, representing a weighted population that varied from 173.9 million in 1999 to 2000 to 215.5 million in 2017 to 2018, of whom 35.6% (95% CI, 34.5% to 36.8%) were eligible for statin use for primary prevention. Results were published Dec. 5 by Annals of Internal Medicine.
From 1999 to 2000 and 2013 to 2014, the proportion of guideline-eligible adults who reported receiving statins increased from 11.6% (95% CI, 7.7% to 15.6%) to 33.6% (95% CI, 27.5% to 39.6%), an increase of 22.0 percentage points (95% CI, 14.7 to 29.2 percentage points). From 2013 to 2014 and 2017 to 2018, statin use did not change significantly (change, −1.2 percentage point; 95% CI, −8.6 to 6.3 percentage points).
The study authors noted that most adults with the strongest guideline recommendations for primary prevention with statins were not receiving them, including those with diabetes, a low-density lipoprotein cholesterol level above 4.92 mmol/L (190 mg/dL), or a 10-year risk of cardiovascular disease more than 20%. They speculated that barriers might include lack of time or buy-in. Electronic health record tools that calculate ASCVD are not routinely implemented and do not address barriers such as competing patient priorities and limited time for shared decision making, the authors said.
“Although the ACC/AHA guidelines expanded indications for primary prevention, they also increased decision-making complexity, requiring new multistep risk calculation,” the authors wrote, noting that their study showed evidence that complexity was problematic. “Our findings showed a lower rate of statin use among patients meeting criteria based on ASCVD risk than among those with easily identifiable indications, such as diabetes or a low-density lipoprotein cholesterol level above 4.92 mmol/L (190 mg/dL).”