Inappropriate Statin Therapy According to Atherosclerotic Cardiovascular Disease (ASCVD) Risk: Can We Do Better?
Fadel RA, Ahluwalia G, Hughes C, Sharma S, Aljamal AO, and Omar J. Inappropriate Statin Therapy According to Atherosclerotic Cardiovascular Disease (ASCVD) Risk: Can We Do Better? J Gen Intern Med 2019; 34(2):S259.
J Gen Intern Med
Background: Statin therapy targeted at reducing 10-year risk of stroke and heart attack has become a cornerstone for preventative health in the outpatient setting. Appropriate statin intensity prescription based on 10-year ASCVD risk calculation can lead to improved morbidity and mortality as outlined by current American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Methods: We conducted an empiric observational study in August 2018 based on lab Results of patients visiting the Henry Ford Hospital Academic Internal Medicine Clinic between January 2017 and December 2017. We calculated the 10-year ASCVD risk for the patients based on this data, and compared the ACC/AHA guideline recommended statin therapy with the one currently prescribed. The primary outcome was appropriateness of statin therapy based on ASVCD risk calculation. Our aim was to assess whether patients in the clinic setting are being adequately managed for ASCVD risk according to ACC/AHA guidelines. Results: Of the 2994 patients assessed, approximately 1548 patients were prescribed an inappropriate intensity of statin based on 10-year ASCVD risk calculation (p < 0.001). For female patients, the odds of appropriate statin dose prescription increased by approximately 81.9% (odds ratio 1-1.819) when compared to male patients (95% CI 1.559-2.124). For black patients, the odds of appropriate statin dose prescription decreased by 32.2% (odds ratio 1-0.678) when compared to white patients (95% CI 0.532-0.864). Asian patients were more likely to be on an appropriate statin dose as compared to non-Asians (p = 0.022), and Hispanic patients were more likely to be on an appropriate statin dose as compared to non-Hispanics (p = 0.005). Approximately 1245 patients currently taking high-intensity statin did not qualify for one based on 10-year ASCVD risk calculation as compared to 484 patients (p < 0.001). Conclusions: There is marked discrepancy in the guideline recommended statin therapy (based on 10-year ASCVD risk calculation) and currently prescribed statin, with gender and race serving as major variables. This data demonstrates a major opportunity for intervention on the part of primary care internists to improve patient outcomes in the outpatient setting.