Clinical Edge

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

Further LDL-C Reduction in Statin-Treated Patients

Across multiple health care systems in Indiana, between 34% and 58% of patients treated with statins did not achieve therapeutic low-density lipoprotein cholesterol (LDL-C) thresholds and may be at increased risk for cardiovascular disease (CVD). The retrospective, longitudinal cohort study sought to: determine how many patients on statins achieved the therapeutic threshold of LDL-C <100 mg/dL (general cohort) and <70 mg/dL (secondary prevention cohort, with preexisting CVD); estimate the number of potentially avoidable CVD events if the threshold were reached; and forecast potential cost savings. Researchers found:

  • Of the 89,267 patients initiating statins, 33.7% did not achieve the LDL-C threshold (secondary prevention cohort: 58.1%).
  • In both groups, not achieving the threshold was associated with patients who were female, black, and those who had reduced medication adherence.
  • Of patients who adhered to the statin therapy regimen, 23.7% of the general cohort and 50.5% of the secondary cohort had LDL-C levels that did not meet the threshold.
  • Achieving therapeutic thresholds would have reduced relative risk by 14.8% and avoided $1,455 per patients in the CVD events treatment costs for the general cohort over a 10-year period.

Citation:

Schleyer T, Hui S, Wang J, et al. Quantifying unmet need in statin-treated hyperlipidemia patients and the potential benefit of further LDL-C reduction through and EHR-based retrospective cohort study. J Manag Care Spec Pharm. 2019;25(5):544-554. doi:10.18553/jmcp.2019.25.5.544.

Commentary:

The 2013 ACC/AHA blood cholesterol treatment guidelines moved away from LDL-C treatment goals and recommended a percent reduction in LDL-C from baseline levels in high risk individuals and patients with clinical ASCVD. Extrapolation of lipid-lowering outcome studies suggest that an LDL-C target of <70 mg/dL may give further risk reduction in secondary prevention patients. This study of nearly 90,000 patients between 2012 and 2016 showed that over 58% of secondary prevention patients treated with statin medications did not achieve an LDL-C less than the 70 mg/dL target. If the less than 70 mg/dL target had been met in this cohort, a further 15% relative risk reduction in CVD events could have been achieved. The 2018 ACC/AHA update to the cholesterol treatment guidelines recommend a 50% or greater LDL-C reduction from baseline and a less than 70 mg/dL LDL-C treatment target in patients with clinical ASCVD. With the new focus on an LDL-C treatment target, the percentage of patients achieving this goal is likely to increase. —Matthew Sorrentino, MD