Journal of clinical lipidology · 2025
Treatment of severe hyperlipidemia and associated cardiovascular outcomes: Data from a large healthcare system.
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Hallihan Cameron, Zhu Jianhui, Thoma Floyd, Nambi Vijay, Mehta Anurag, Agarwala Anandita, Marroquin Oscar, Mulukutla Suresh, Saeed Anum
Аннотация
BACKGROUND: High intensity statin therapy is currently recommended for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in patients with severe hyperlipidemia (HLD), defined as low-density lipoprotein cholesterol (LDL-C) of ≥190 mg/dL.
OBJECTIVE: We investigated rates and dosages of statin use and associated ASCVD outcomes for patients with severe HLD.
METHODS: In a large healthcare system network, patients without ASCVD with an LDL-C ≥ 190 mg/dL were identified and stratified further based on American College of Cardiology /American Heart Association 10-year risk score. Statin use was stratified as: guideline directed statin intensity (GDSI) (high intensity statin) or <GDSI (less than high intensity) or no statin use. Time to initiation of GDSI was calculated using the Kaplan-Meier method. Incident rates (per thousand person years) and Cox proportional hazards models were used to assess the relationship between statin use and adverse outcomes.
RESULTS: Out of 282,298 primary prevention patients, a total of 5205 (1.8%) had LDL-C ≥ 190 mg/dL out of whom 3.7% were on GDSI at the index visit. Over a 5-year follow up, 42% of high-risk patients with severe HLD achieved new GDSI initiation. Compared to patients on GDSI, those on no statin therapy were at significantly higher risk of myocardial infarction (MI) (hazard ratio [HR] = 2.36, 95% CI [1.38-4.04]) and stroke/transient ischemic attack (HR = 2.70, 95% CI [1.43-5.09]). Patients on <GDSI were found to have significantly higher risk of MI (HR = 1.72, 95% CI [1.05-2.81]) compared to patients on GDSI.
CONCLUSION: High intensity statins are underutilized among patients with severe HLD, which is linked to greater risk of ASCVD events.
OBJECTIVE: We investigated rates and dosages of statin use and associated ASCVD outcomes for patients with severe HLD.
METHODS: In a large healthcare system network, patients without ASCVD with an LDL-C ≥ 190 mg/dL were identified and stratified further based on American College of Cardiology /American Heart Association 10-year risk score. Statin use was stratified as: guideline directed statin intensity (GDSI) (high intensity statin) or <GDSI (less than high intensity) or no statin use. Time to initiation of GDSI was calculated using the Kaplan-Meier method. Incident rates (per thousand person years) and Cox proportional hazards models were used to assess the relationship between statin use and adverse outcomes.
RESULTS: Out of 282,298 primary prevention patients, a total of 5205 (1.8%) had LDL-C ≥ 190 mg/dL out of whom 3.7% were on GDSI at the index visit. Over a 5-year follow up, 42% of high-risk patients with severe HLD achieved new GDSI initiation. Compared to patients on GDSI, those on no statin therapy were at significantly higher risk of myocardial infarction (MI) (hazard ratio [HR] = 2.36, 95% CI [1.38-4.04]) and stroke/transient ischemic attack (HR = 2.70, 95% CI [1.43-5.09]). Patients on <GDSI were found to have significantly higher risk of MI (HR = 1.72, 95% CI [1.05-2.81]) compared to patients on GDSI.
CONCLUSION: High intensity statins are underutilized among patients with severe HLD, which is linked to greater risk of ASCVD events.