Statins not commonly used among younger cohorts even after ASCVD diagnosis

Among patients ages 18 to 44 years diagnosed with atherosclerotic cardiovascular disease (ASCVD), there has been no improvement in statin use over two decades, a study showed.

The study explored trends in statin use and other risk factors from 1999 to 2020, with a specific focus on age, using data from the National Health and Nutrition Examination Survey. Researchers looked at patients ages 18 years and older diagnosed with ASCVD, a total of 6,354 individuals, with 3,171 participants (51.49% of the sample) using statins for secondary ASCVD prevention. Results were published Aug. 9 as a research letter by Mayo Clinic Proceedings.

In patients ages 18 to 45 years, 46 to 65 years, and 65 years and older, smoking rates were 43.01%, 33.43%, and 10.39%, respectively (P<0.001), with a similar trend for alcohol use. In patients aged 18 to 45 years, 46 to 64 years, and 65 years and older, the prevalence of hypertension was 51.11%, 72.95%, and 78.31%, respectively (P<0.001), with similar results for dyslipidemia and diabetes. Statin use increased from 35.33% (95% CI, 30.78% to 39.87%) in 1999 to 59.28% (95% CI, 51.30% to 67.25%) in 2012, then stabilized at approximately 60% in 2020.

In patients ages 18 to 44 years, statin use was 18.34% (95% CI, 0.18% to 36.50%) in 1999 and 16.63% (95% CI, 0.36% to 32.91%) in 2020. For those ages 45 to 64 years, use increased from 39.33% (95% CI, 29.62% to 49.05%) in 1999 to 54.97% (95% CI, 47.10% to 62.83%) in 2020. In the group ages 65 years and older, use increased from 35.17% (95% CI, 29.57% to 40.77%) in 1999 to 60.62% (95% CI, 55.73% to 65.51%) in 2010 and 68.62% (95% CI, 63.65% to 73.60%) in 2020. An interaction effect was seen between statin use and age (P<0.001).

The study authors noted that in the past 20 years, there had been an increasing trend in the overall use of statins for secondary prevention, particularly in the population older than age 45 years. However, those ages 18 to 44 years who qualified for statins for secondary prevention showed no increase and an overall rate of use that was significantly lower than in the other age groups.

“Moreover, our study revealed a lower prevalence of hypertension, diabetes, and dyslipidemia in the 18- to 44-year age group,” the authors wrote. “This may explain the lower utilization rate and the lack of improvement in statin use trends for individuals in this age group. However, it is crucial to underscore that these individuals have already been diagnosed with ASCVD.”