Younger Patients With High LDL-C Get Fewer Statin Prescriptions

By Larry Hand
WebMD Health News

January 06, 2017

Statin prescription rates vary widely by age among individuals with severe dyslipidemia, with people younger than 40 years receiving fewer prescriptions, according to new research.

"Our data suggest that in general, patients with severely elevated cholesterol are prescribed a standard first-line medicine two-thirds of the time. But if you had a previous heart attack and/or diabetes as well, then the rates were higher, up to 93% with all three conditions," Dr David A Zidar (University Hospitals Cleveland Medical Center) told heartwire from Medscape.

But "surprisingly, the likelihood that a patient might go untreated and slip through the cracks, so to speak, depends most importantly on their age," he continued. "In this analysis, younger patients were much more likely to go untreated. Below age 40, only 45% of patients received a prescription."

Zidar and colleagues analyzed inpatient and outpatient encounters from a national clinical registry (IBM Explorys) that has data from 360 medical centers and all 50 US states. They included all patients between age 20 and 75 years who had both LDL-cholesterol and pharmacy records between July 1, 2013 and July 31, 2016.

They defined statin use as any statin at any dose during the study period for patients with LDL-C of 190 mg/dL or higher, patients with diabetes and LDL-C higher than 70 mg/dL, and patients with atherosclerotic cardiovascular disease (ASCVD).

The researchers found that almost 110,000 (3.8%) of 2,884,260 patients with a qualifying lipid analysis had an LDL-C level of 190 mg/dL or higher, according to an article published online January 4, 2017 in JAMA Cardiology.

However, in this study, statin prescription rates varied widely by age. The rates came to 32% for patients in their 30s, 47% for patients in their 40s, and 61% for patients in their 50s.

Age 40 or older was the strongest predictor of statin prescription (adjusted odds ratio [AOR] 2.87, 95% CI 2.76–2.99; P‹0.001), followed by male sex (AOR 1.08, 95% CI 1.05–1.11; P‹0.001), nonwhite race (AOR 1.10, 95% CI, 1.07–1.14; P‹0.001), and self-pay status (AOR 1.16, 95% CI 1.10–1.23; P‹0.001).

Overall, patients with severe dyslipidemia but without diabetes or ASCVD had a statin prescription rate of 66%. That compares with 69% for patients with diabetes but no ASCVD and 68% for patients with ASCVD but no diabetes.

The researchers found that 25% of patients with severe levels of LDL-C (›250 mg/dL and ›300 mg/dL) did not receive statin prescriptions.

The statin prescription rate for patients with LDL-C 190 mg/dL or higher and with diabetes or ASCVD came to 84%, while the rate for patients with all three conditions came to 93%.

Preventing heart disease "requires that we find these patients young and act decisively, even before they experience symptoms or other risk factors for heart disease," Zidar said. "To the extent that this is often a genetic disease, we can then also more easily identify siblings or children and treat them early as well.

"The fact that we saw markedly lower rates of statin prescription in these younger, uncomplicated patients was surprising to us initially, but as we reflect on it, these results have implications that we hope to capitalize on," he continued.

"For instance, these data may stem from common misconceptions both on the part of physicians and patients. In a young, healthy, and active patient, a physician might be inclined to urge patients to improve these extreme cholesterol levels with diet and exercise alone. However, physicians must recognize that this degree of dyslipidemia is generally unable to be adequately corrected by changes in lifestyle alone, often because it is genetic in origin."

The National Center for Advancing Translational Sciences funded this research through the Clinical and Translational Science Collaborative of Cleveland. The authors reported no relevant financial relationships.

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SOURCE: Medscape, January 06, 2017.

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