Real-World Evaluation of Lipid Testing Rate and Treatment Target Attainment Among High-Risk Patients: Post Release of the 2018 AHA/ACC Practice Guidelines
Jay Visaria PhD, Eric Stanek PharmD, Jeff White PharmD, Mark Cziraky PharmD, Nilesh Gangan PhD
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引用次数: 0
Abstract
Background/Synopsis
The 2018 AHA/ACC clinical practice guidelines set standards for treatment selection and low-density lipoprotein cholesterol (LDL-C) lowering among patients with atherosclerotic cardiovascular disease (ASCVD) and/or type 2 diabetes mellitus (T2DM). However, real-world evidence on rates of lipid testing and LDL-C target attainment following guideline directed treatment (GDT) post-release of practice guidelines is limited.
Objective/Purpose
To assess the rates of lipid testing among patients with ASCVD and/or T2DM pre and post initiating statins or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) and the extent of LDL-C target attainment in 12 months post-initiation after GDT versus non-GDT post-release of practice guidelines.
Methods
Adults initiating statins or PCSK9i between 01/01/2019 and 12/31/2020 with prior evidence of ASCVD and/or T2DM, and health plan enrollment for 12-month pre- and post-index pharmacy claim date (either statin or PCSK9i) were identified from the Healthcare Integrated Research Database. Lipid testing patterns and LDL-C target attainment rates (<70mg/dL) based on procedure codes or available lab results were examined. GDT was defined as high-intensity statin initiation in patients with ASCVD, moderate- or high-intensity statin initiation in patients with T2DM without ASCVD, PCSK9i in patients with ASCVD added to high-intensity statin and sustained high-intensity statin while persistent on PCSK9i during the 12 months follow-up period. Descriptive statistics were reported, and no statistical testing was performed.
Results
In total, 71,581 statin initiators with ASCVD/T2DM, and 3,038 PCSK9i initiators with ASCVD were included (mean age: 61-65 years; males: 55-60%). Among statin initiators and PCSK9i initiators with prior ASCVD, 72% and 79% had lipid testing during 12-month baseline, and 69% and 75% during 12-month follow-up, respectively. LDL-C target attainment rates during 12-month post-initiation among a subset of patients with at least one valid LDL-C measurement is as follows: 53% in GDT statin initiators with prior ASCVD versus 35% for non-GDT, 35% in GDT statin initiators with prior T2DM without ASCVD versus 16% for non-GDT, 65% among GDT PCSK9i initiators with prior ASCVD versus 53% for non-GDT, and 80% among patients with prior ASCVD with sustained high-intensity statin while persistent on PCSK9i versus 64% for non-persistent PCSK9i/statin.
Conclusions
Lipid testing rates were moderate. LDL-C target attainment in high-risk patients with lipid testing treated per 2018 AHA/ACC guidelines (i.e., GDT) were modestly improved versus non-GDT. Interventions to improve lipid testing rate may increase opportunities for treatment modification based on guidelines and better LDL-C target attainment to help reduce the risk of cardiovascular events.
期刊介绍:
Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.