Treatment of severe hyperlipidemia and associated cardiovascular outcomes: Data from a large healthcare system.

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.