Real-world prescribing in accordance to ACC/AHA guidelines for lipid-lowering therapy in high-risk primary and secondary prevention of ASCVD: Real-World Prescribing for Lipid-Lowering Therapy

Objective: The value of lipid lowering therapy (LLT) for prevention of atherosclerotic cardiovascular disease (ASCVD) is well understood. American College of Cardiology and American Heart Association guidelines recommend statin therapy for secondary and high-risk primary ASCVD prevention. Prior studies have identified incomplete uptake of these guidelines in specific practice settings or patient populations. Here we characterized real-world LLT prescribing relative to guideline recommendations across seven US health systems. Methods: Cross-sectional analyses of records from the PaTH Clinical Research Network focused on three cohorts: adults with ASCVD (ASCVD cohort), those aged 40–75 without ASCVD but with diabetes mellitus (DM cohort), and those not in either prior category but with a history of low-density lipoprotein (LDL-C) >190 mg/dl (LDL-C cohort). We describe patient characteristics, patterns of care, lipid values, and documented LLT within each cohort and variation between health systems. Results: We identified 240,625 patients within the ASCVD cohort (LDL-C mean 86, SD 40 mg/dL), 113,662 patients in the DM cohort (LDL-C mean 93, SD 37 mg/dL), and 11,276 patients in the LDL-C cohort (LDL-C mean 208, SD 33 mg/dL. Among ASCVD cohort members, 37 % achieved the target LDL-C < 70 mg/dL, 62 % were prescribed LLT, 34 % were prescribed guideline-concordant high-intensity statin therapy. In the DM cohort, 27 % had LDL-C < 70 mg/dl, 54 % were on statin therapy, 19 % on high-intensity statin therapy. In the LDL-C cohort, 97 % had an LDL-C > 160 mg/dl, 44 % were on statin therapy and 16 % on high-intensity statin therapy. There was significant variability in documented LLT between health systems. Conclusions: In this real-world descriptive study across multiple health systems for patients meeting criteria for secondary or high-risk primary ASCVD prevention, most patients had no documented high-intensity statin prescriptions and did not meet LDL-C targets. There was significant variability in care across health systems. Opportunities remain for improvement in guideline adherence to reduce ASCVD risk.