Most adults eligible for statins do not receive them

Key takeaways:

• The proportion of eligible adults using statins peaked at 35.6% between 2013-2018.
• Time constraints may prevent physicians from routinely calculating patients’ atherosclerotic CVD risk.

Most adults who are eligible for statin use to prevent CVD are not receiving them, according to a study published in Annals of Internal Medicine.

In 2013, the American College of Cardiology (ACC) and American Heart Association (AHA) expended statin eligibility for primary prevention “on the basis of atherosclerotic [CVD] (ASCVD) risk score,” Casey J. Kim, MD, an internist from the department of medicine at Beth Israel Deaconess Medical Center, and colleagues wrote.

“Previous studies have examined recent trends in statin use for primary prevention but have not assessed the effect of guideline changes,” they noted. “We hypothesized greater increases in statin use for primary prevention among adults newly recommended statins by the ACC/AHA guidelines.”

The researchers examined National Health and Nutrition Examination Survey data from 1999 to 2018 to determine statin trends.

The final analysis included 21,961 adults, who represented a weighted population of 173.9 million in 1999-2000 and 215.5 million in 2017-2018. Of those, 35.6% (95% CI, 34.5%-36.8%) had an indication for statin use for primary prevention.

Kim and colleagues found that the proportion of guideline-eligible adults who reported receiving statins rose from 11.6% (95% CI, 7.7-15.6) in 1999-2000 to 33.6% (95% CI, 27.5-39.6) in 2013-2014, representing an increase of 22 percentage points (95% CI, 14.7-29.2).

However, from 2013-2014 to 2017-2018, there was no significant change in statin use among eligible patients (change = –1.2 percentage point; 95% CI, –8.6 to 6.3 percentage points).

Similarly, among adults who were newly eligible to receive statins under the expanded guidelines, there was no significant change in the proportion of statin users from 2013-2014 to 2017-2018 (change = –2.1 percentage points; 95% CI, –15.1 to 11). Also, during this period, the proportion of adults with the strongest indications who used statins did not significantly change, including adults with:

• diabetes (change = 6.8 percentage points; 95% CI, –7.3 to 21); and
• ASCVD risk above 20% (change = –0.4 percentage point; 95% CI, –13.2 to 12.3).

“Although the ACC/AHA guidelines expanded indications for primary prevention, they also increased decision-making complexity, requiring new multistep risk calculation,” the researchers wrote. “Many clinicians do not routinely use cardiovascular risk calculators because of lack of time, input availability, or buy-in.”
Although electronic health records can calculate ASCVD risk, Kim and colleagues noted that “they are not routinely implemented and do not address other barriers, such as competing patient priorities and limited time for shared decision-making.”