Despite Recommendations, Use of Statins To Prevent Heart Attacks and Stroke Has Remained Unchanged

The rate of statin use to prevent cardiovascular events such as heart attacks and strokes among people with cardiovascular disease remained unchanged from 2008 to 2016 despite American College of Cardiology/American Heart Association guidelines, which recommended their use for secondary prevention and the availability of generics, according to an AHRQ-funded study. Cardiovascular disease remains the leading cause of death in the United States. Statins lower cholesterol levels, prevent disease progression and adverse cardiovascular events, and reduce mortality. The study published in the Journal of the American Board of Family Medicine found that from 2014 to 2016, more than 40 percent of people ages 40 years and older with a history of cardiovascular disease—about 9.5 million Americans—did not use statins, despite the recommendations. Increasing age and having been diagnosed with high cholesterol were associated with higher odds of statin use, while being female or Hispanic were associated with lower odds of statin use. The study underscores the need for efforts to increase uptake of this evidence-based therapy while at the same time reducing disparities. The study was based on data from AHRQ’s Medical Expenditure Panel Survey. Access the abstract.

2019 Nov-Dec;32(6):807-817. doi: 10.3122/jabfm.2019.06.180313.

Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal.

Ngo-Metzger Q1, Zuvekas S2, Shafer P2, Tracer H2, Borsky AE2, Bierman AS2.

Author information

Abstract

BACKGROUND:

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality in the United States. The purpose of this study is to examine the rates of statin use for secondary prevention of ASCVD events in the United States over the last decade and determine whether disparities in the treatment of ASCVD still persist among women and racial/ethnic minorities.

METHODS:

We conducted a trend analysis using data from 2008 through 2016 to describe age-adjusted trends in the use of statins for secondary prevention using the Medical Expenditure Panel Survey. We also conducted a multivariable logistic regression analysis to determine whether sociodemographic characteristics are associated with statin use during the 3 years that followed the publication of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline (2014 through 2016).

RESULTS:

The prevalence of statin use among those with a history of ASCVD remained unchanged from 2008 through 2016. In 2014 to 2016, more than 40% of those aged 40 years and older with a history of ASCVD did not use statins, corresponding to approximately 9.5 million Americans. Increasing age and having been diagnosed with high cholesterol (odds ratio [OR], 6.22; P < .001) were associated with higher odds of statin use while being female (OR, 0.65; P < .001) or Hispanic (OR, 0.69; P = .011) were associated with lower odds of statin use.

CONCLUSIONS:

Our study found there was no increase in the national rates of statin use following the ACC/AHA 2013 secondary prevention guideline and the availability of generic statins. Significant gender and ethnic disparities in ASCVD treatment remained in the United States.

KEYWORDS:

Atherosclerosis; Cardiovascular Diseases; Chronic Disease; Hypercholesterolemia; Hyperlipidemia; Logistic Models; Preventive Medicine; Secondary Prevention; Statins; Surveys and Questionnaires