Among patients with low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL, evidence-based lipid-lowering therapy (LLT) use remains low with significant variation in care, a new study found. Using data from the American College of Cardiology National Cardiovascular Data Registry-Practice Innovation and Clinical Excellence registry, researchers assessed the proportion of patients with LDL-C ≥190 mg/dL (n=49,447) receiving statin, high intensity statin, LLT associated with ≥50% LDL-C lowering, ezetimibe, or a PCSK9 inhibitor between January 2013 and December 2016. Practice-level rates and variation in LLT use were also assessed. They found:
- The proportion of patients receiving a statin, high-intensity statin, LLT associated with ≥50% LDL reduction, ezetimibe, or PCSK9 inhibitor were 58.5%, 31.9%, 34.6%, 8.5%, and 1.5%, respectively.
- Median practice-level rates and adjusted median rate ratio (MRR) for statin (MRR, 1.20), high-intensity statin (MRR, 2.31), LLT with ≥50% LDL lowering (MRR, 2.12), ezetimibe (MRR, 2.42), and PCSK9 inhibitors (MRR, 2.38) indicated significant gaps and >200% variation in receipt of several of these medications for patients across practices.
- Even larger treatment gaps were noted among those without concomitant ASCVD.
Virani SS, Kennedy KF, Akeroyd JM, et al. Variation in lipid-lowering therapy use in patients with low-density lipoprotein cholesterol ≥190 mg/dL: Insights from the National Cardiovascular Data Registry-Practice Innovation and Clinical Excellence Registry. [Published online ahead of print May 10, 2018]. Circ Cardiovasc Qual Outcomes. doi:10.1161/CIRCOUTCOMES.118.004652.