American College of Physicians: Internal Medicine — Doctors for Adults ®


ACP Internist® Weekly

In the News for the Week of January 10, 2017



Statins often not prescribed in younger patients with dyslipidemia, study finds

Younger patients with severe dyslipidemia often do not receive statins, according to a recent study.

Researchers used data from a U.S. national clinical registry of 360 medical centers to determine the rate of statin prescriptions in patients who had been screened for dyslipidemia. Patients 20 to 75 years of age who had information available on LDL cholesterol levels and pharmacy records between July 1, 2013, and July 31, 2016, were included.

Patients who had at least one indication for statin therapy were analyzed according to the following groups: LDL cholesterol level of at least 190 mg/dL, diabetes and LDL cholesterol level above 70 mg/dL, and atherosclerotic cardiovascular disease (ASCVD). Statin use was defined as prescription of any dose of any statin during the study period. The study results were published online as a research letter by JAMA Cardiology on Jan. 4.

A total of 2,884,260 patients were qualified for the study, and of these, 109,980 (3.8%) had an LDL cholesterol level of at least 190 mg/dL. These patients with severe dyslipidemia but no diabetes or established ASCVD had a statin prescription rate of 66%. Those with diabetes but no ASCVD had a prescription rate of 69%, and those with ASCVD but no diabetes had a prescription rate of 68%. Among patients with very high levels of LDL cholesterol (i.e., >250 mg/), 25% did not receive a prescription for statins. Patients 40 to 75 years of age who had LDL cholesterol levels of 190 mg/dL or higher were more likely to receive statins if they had another indication for statin therapy.

Younger patients with severe dyslipidemia were significantly less likely to be prescribed statins, with rates of 32%, 47%, and 61% for those in their 30s, 40s, and 50s, respectively. In a multivariable logistic regression model, age was the strongest predictor of statin therapy among patients with an LDL level of 190 mg/dL or higher (adjusted odds ratio for age 40 years and older, 2.87; P<0.001), with male sex, nonwhite race, and self-payment as other independent predictors.

The researchers concluded that patients with severe dyslipidemia were more likely to be prescribed statins if they had additional indications and that statin prescriptions were strongly affected by patient age, with fewer than 45% of patients younger than age 40 who had a clear indication for treatment receiving the drug. The latter finding is particularly relevant, the authors said, due to the link between familial hypercholesterolemia and early onset of ASCVD and cardiovascular death in the era before statins. The authors noted that current guidelines recommend against use of ASCVD risk calculators for patients 21 years of age and older who have primary LDL cholesterol levels above 190 mg/dL, due to the risk of inappropriate deferral of statin therapy.

“Specific interventions that optimize the follow up of younger patients after lipid screening may be needed to realize the potential for improved survival and cost reduction associated with the treatment of severe dyslipidemia,” the authors wrote.

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