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Younger patients with severe dyslipidemia less likely to receive statins
The statin prescription rate for patients with severe dyslipidemia is 66%, with age being the most important predictor, as younger patients are less likely to receive a statin prescription, according to new data.
Sadeer G. Al-Kindi, MD, of the Harrington Heart & Vascular Institute at University Hospitals Cleveland Medical Center, and colleagues analyzed data from Explorys, a national clinical registry that includes inpatient and outpatient data from 360 medical centers in all 50 states. The researchers included all patients aged 20 to 75 years with documented LDL levels and pharmacy records from July 2013 to July 2016.
Of the cohort analyzed, 3.8% (n = 109,980) had an LDL level 190 mg/dL.
For patients with severe dyslipidemia but without diabetes or atherosclerotic CVD, the statin prescription rate was 66%. For patients with diabetes but not atherosclerotic CVD, the statin prescription rate was 69%, and for patients with atherosclerotic CVD but not diabetes, the prescription rate was 68%, according to the researchers.
When patients had LDL levels 190 mg/dL and multiple statin indications, the rates of statin prescription were higher. Patients with severe dyslipidemia, diabetes and atherosclerotic CVD had a prescription rate of 93%, the researchers wrote.
Statin prescription rates were lower with younger age. Among patients aged 30 to 39 years with severe dyslipidemia, 32% were prescribed statins. The rates were 47% for patients aged 40 to 49 years and 61% for patients aged 50 to 59 years. When the researchers constructed a multivariable logistic regression model, they found age was the most important predictor of statin prescription (adjusted OR for age 40 years or older = 2.87; 95% CI, 2.76-2.99).
Other independent predictors were male sex (adjusted OR = 1.08; 95% CI, 1.05-1.11), nonwhite race (adjusted OR = 1.1; 95% CI, 1.07-1.14) and self-pay status (adjusted OR = 1.16; 95% CI, 1.1-1.23).
“This finding has particular relevance given the early onset of [atherosclerotic CVD] and [CV] death observed in familial hypercholesterolemia studies from the pre-statin era. For this reason, for patients with primary LDL elevation level of 190 mg/dL or greater and who are 21 years or older, current guidelines recommend against the use of an [atherosclerotic] CVD risk calculation, which could inappropriately lead to the deferral of statin therapy for these high-risk patients,” the researchers wrote. “Specific interventions that optimize the follow-up of younger patients after lipid screenings may be needed to realize the potential for improved survival and cost reduction associated with the treatment of severe dyslipidemia.” – by Cassie Homer
Disclosures: The researchers report no relevant financial disclosures.