Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Do Guidelines Impact Cholesterol Management?

Following the release of the 2013 ACC/AHA guidelines, high-intensity statin use among secondary prevention patients increased significantly, primarily in patients managed by subspecialists. This according to a single-system cohort study of adults with ≥1 claim for a statin and ≥1 atherosclerotic cardiovascular disease (ASCVD) diagnosis in propensity score-matched analyses. Researchers found:

  • Among 1,938 patients (mean age 70 years, 48% female) with ASCVD, the percentage on high-intensity statin therapy significantly increased from 24% in 2013 to 49% in 2016.
  • This increase was 13% to 22% higher among patients managed by cardiologists and endocrinologists.
  • Mean low-density lipoprotein cholesterol (LDL-C) and the proportion of patients reaching LDL-C <70 mg/dL and <100 mg/dL remined unchanged across comparison cohorts.

Citation:

Yu S, Zolfaghari K, Rascati KL, Copeland LA, Godley PJ, McNeal C. Guidelines impact cholesterol management. [Published online ahead of print March 18, 2019]. J Clin Lipidol. doi:10.1016/j.jacl.2019.03.002.

Commentary:

Are guidelines effective in changing medical practice and improving outcomes? The 2013 ACC/AHA lipid guidelines diverged from an LDL treatment target recommendation to suggesting a 50% or greater LDL reduction with a high intensity statin for patients with ASCVD. This study showed that over a four-year period the percentage of patients appropriately treated with a high intensity statin increased from 24% to 49%, especially in patients treated by specialists. The mean LDL-C achieved in this cohort was about 82 mg/dL and was not significantly lower with the adoption of the guidelines. Only about 56% of the patients achieved an LDL-C <70 mg/dL. This suggests that it may be difficult to achieve an LDL-C <70 mg/dL in the highest risk patients as recommended by the 2018 update to the lipid guidelines. —Matthew Sorrentino, MD