March 20, 2020
In 2013, the American College of Cardiology and American Heart Association (ACC/AHA) released cholesterol guidelines identifying which patients should be considered candidates for statin therapy. Yet according to recently published findings in Clinical Cardiology by Allina Health and Minneapolis Heart Institute Foundation® (MHIF) researchers, more than four years after the initial release of the guidelines, approximately four in 10 patients for whom a statin would be appropriate were still not being prescribed the medication.
“When the 2013 guidelines were first released, they were estimated to lead to a dramatic increase in statin use across the U.S.,” said Dr. Michael Miedema, a research cardiologist at MHIF and director of cardiovascular prevention at the Minneapolis Heart Institute® at Allina Health who led the study. “Despite a large body of evidence showing that statins are effective in preventing cardiovascular disease and generally safe for long-term use, we failed to find an increase in use of statin therapy in recent years.”
The researchers first looked at data on more than 200,000 patients from 2013 — before the guidelines were released — and found that 61 percent of patients at a large health care system who met statin eligibility under the new guidelines were already being prescribed a statin. Additionally, when researchers examined the data four years after the guidelines, they found minimal change, with only 62 percent of statin-eligible patients receiving a statin.
Abbey Sidebottom, principal research scientist for care delivery research at Allina Health and the publication’s lead author, explained, “We wanted to do the study given that national estimates show full implementation of the guidelines would have significant potential to help save lives. It’s estimated that by treating all statin-eligible adults who are currently untreated, we could prevent more than 240,000 atherosclerotic cardiovascular disease (ASCVD) events every year in the U.S., which include coronary heart disease, cardiovascular deaths, and fatal and nonfatal strokes.”
The study also found a gender disparity: Despite heart disease being the #1 killer of women as well as men, women were less likely to receive statin therapy. Of statin-eligible men, 66 percent were prescribed a statin compared to 57 percent of statin-eligible women. Women were less likely to receive treatment within each of the statin eligibility categories.
“By improving the adoption of the cholesterol guidelines, there is significant potential to reduce coronary artery disease rates at a population level,” said Dr. Miedema. “Prevention is a key area of research where we know we can have a great impact in the care and outcomes for patients. We are planning a follow-up study in partnership with clinics to identify the best strategies to help providers treat patients according to the guidelines. We hope other large health systems will then be able to leverage our learnings to provide optimal care to millions of patients at risk for heart disease across the country and the world.”
Dr. Miedema served as a member of the evidence review committee for the 2018 AHA/ACC Cholesterol Guidelines and as a committee member for the 2019 ACC/AHA Guidelines for Primary Prevention of CVD, both of which reinforced the 2013 guideline criteria. Listen to him discuss the guideline and learn more.
Committed to Prevention Research
MHIF has a long history of groundbreaking research and education across a wide spectrum of prevention-related topics, including coronary artery calcium testing, blood pressure, cholesterol and statin use, nutrition and lifestyle behaviors, risk factors and screening for specific populations, premature heart disease and genetic disorders. MHIF researchers also led a 10-year transformative population health research project in rural New Ulm, Minnesota, that resulted in significant improvements for cardiovascular disease risk factors in the community. Prevention continues to be a key area of research as part of MHIF’s commitment to creating a world without heart and vascular disease.