Despite Recent Improvements, Gaps in Statin Use Remain a Cause for Concern

Peter Noseworthy, MD

A new study from a team at the Mayo Clinic is detailing the underuse of statins for secondary prevention in patients with atherosclerotic cardiovascular disease (ASCVD) in recent years.

Using the OptumLab Data Warehouse database, investigators found that while moderate improvements occurred, major gaps still existed when examining statin use in US patients from 2007-2016.

"The risk of adverse outcomes has decreased overall. However, it is apparent that major treatment gaps exist in our country," said senior investigator Peter Noseworthy, MD, a Mayo Clinic cardiologist, in a statement from the Mayo Clinic. "Although the guidelines recommend statins for stroke, TIA and peripheral artery disease, there appears to be an unwillingness to consider these and cardiovascular disease equally treatable with statins."

With a lack of adherence to statin therapy posing a real danger to many patients, Noseworthy and colleagues from the Mayo Clinic sought to describe the proportion of patients adhering to therapy and how recent guidelines have impacted use. Investigators designed their analysis as a retrospective cohort study using the OptumLab Data Warehouse database with the aim of assessing trends in the use, adherence, cost, and outcomes of statin therapy for secondary prevention among adult patients who experienced their first ASCVD event between January 1, 2007, and December 31, 2016.

For the purpose of the analysis, ASCVD was defined as myocardial infarction, angina, cardiovascular heart disease (CHD), ischemic stroke, transient ischemic attack (TIA), or peripheral artery disease (PAD). In total, investigators identified 284,954 patients who experienced a first ASCVD event during the study period, including 104,500 with CHD, 60,866 with ischemic stroke or TIA, and 119,588 with PAD. The study cohort had a median age of 63 years (IQR, 54-72), 45.1% were women, and 72.9% were White.

When comparing 2007 to 2016, investigators found use of statins in the first 30 days after discharge increased from 50.3% in 2007 to 59.9% in 2016. In the same analysis, investigator founds use of high-intensity statins increased from 25.0% in 2007 to 49.2% in 2016 and adherence increased from 58.7% in 2007 to 70.5% in 2017 (P <.001 for all trends).

Despite similar treatment benefits, further analysis suggested patients with CHD had greater rates of statin use, high-intensity statins, and adherence to medications than those with ischemic stroke, TIA, or PAD. An analysis of out-of-pocket cost per 30-day decreased from a median of $20 (IQR, 7.6-31.9) in 2007 to $2 (IQR, 1.6-10.0) in 2016 (P <.001). Investigators noted the use of generic statins increased from 42.0% in 2007 to 94.9% in 2016 (P <.001). Additionally, investigators pointed out major adverse cardiovascular events among patients decreased from 8.9% in 2007 to 6.5% in 2016 (P <.001), but statin intolerance increased from 4.0% in 2007 to 5.1% in 2016 (P <.001).

Multivariable regression analysis revealed Black (OR, 0.61; 95% CI, 0.59-0.64; P <.001), Hispanic, (OR, 0.60; 95% CI, 0.58-0.63; P <.001), and Asian (OR, 0.86; 95% CI, 0.81-0.92; P <.001) individuals were less likely to adhere to medications than White individuals. This analysis also suggested women were less likely to adhere to medications than men (OR, 0.86; 95% CI, 0.84-0.88; P <.001).

"Gaps in both prescribing and continuation of statins for at least a year after discharge among women, and Black, Hispanic and Asian people mean that they will be more likely to experience avoidable adverse outcomes," said lead investigator Xiaoxi Yao, PhD, a health sciences researcher at Mayo Clinic, in the aforementioned statement. "If your physician prescribes statins, please adhere to the drugs.”

This study, “Assessment of Trends in Statin Therapy for Secondary Prevention of Atherosclerotic Cardiovascular Disease in US Adults From 2007 to 2016,” was published in JAMA Network Open.