--- title: "Statin use and LDL in statin-treated patients with ASCVD. | Sutter Health" description: "Modest LDL-C lowering for secondary ASCVD prevention is likely driven by suboptimal adherence and low high-intensity statin Rx's & low tx intensification rates." url: "https://www.sutterhealth.org/research/publications/statin-use-and-ldl-in-statin-treated-patients-with-ascvd-1055312752" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Statin use and LDL in statin-treated patients with ASCVD. # Statin utilization and low-density lipoprotein cholesterol in statin-treated patients with atherosclerotic cardiovascular disease: trends from a community-based health care delivery system, 2002-2016. Romanelli RJ, Ito MK, Karalis DG, Huang HC, Iorga SR, Kam IW, Thompson S, & Azar KMJ. _J Clin Lipidol. pii: S1933-2874(20)30068-4. doi: 10.1016/j.jacl.2020.03.006. \[Epub ahead of print\]_ 2020-04-10 ## Abstract BACKGROUND: A better understanding of patterns in statin utilization and low-density lipoprotein cholesterol (LDL-C) among patients with atherosclerotic cardiovascular disease (ASCVD) in a clinical practice setting is needed. OBJECTIVES: The objective of this study was to examine statin utilization and LDL-C among new statin users with ASCVD. METHODS: This retrospective study used an electronic health record database from a community-based health care system. We identified ASCVD patients ≥21 years of age with a new statin prescription during the study period (2002-2016). Outcomes included high-intensity statin therapy (HIST) prescribing at treatment initiation, medication adherence (defined as proportion of days covered ≥0.80), statin therapy titrations rates, and changes in LDL-C during follow-up. RESULTS: Among 6199 eligible patients, mean follow-up was 16.8 months. At treatment initiation, 16.6% of patients received HIST. Approximately 53% of patients were adherent to statin regimens. Mean percent reduction in LDL-c was 25% during follow-up; 18% of patients, overall, and 30% of those initiating on HIST attained LDL-C reductions >50%. Rates of statin intensity-level increases were 8.4 per 100 person-years. HIST prescribing increased over time, beginning after generic atorvastatin availability and preceded treatment guidelines by two years. Initiation on HIST, higher adherence, and treatment intensification during follow-up were independent predictors of attaining LDL-C goals of <70 mg/dL or <100 mg/dL. CONCLUSIONS: In a community-based health care system, modest LDL-C lowering for secondary ASCVD prevention is likely driven by suboptimal adherence and low HIST prescribing and treatment intensification rates. Clinician and patient education are needed to reduce clinical inertia and improve medication adherence to better manage ASCVD. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/32362513) ![Kristen M J Azar, RN, MSN, MPH](https://dyn.mktgcdn.com/p/rFmyR1kiX8JzE5-XNwup0gVC1GRaVTlH7oSDlG0Tr5A/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Kristen M J Azar, RN, MSN, MPH Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/kristen-m-j-azar-rn-msn-mph-1049680985) ## Research topics - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) - [Prevention and Health Maintenance](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Prevention+and+Health+Maintenance%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Atherosclerotic cardiovascular disease risk prediction in disaggregated Asian and Hispanic subgroups using electronic health records.](https://www.sutterhealth.org/research/publications/cvd-risk-prediction-in-asian-and-hispanic-subgroups-in-ehrs-1055312765) Rodriguez F, Chung S, Blum MR, Coulet A, Basu S, Palaniappan LP. J Am Heart Assoc. 8(14):e011874. doi: 10.1161/JAHA.118.011874. Epub 2019 Jul 11. 2019 Jul 16 - Publication ### [Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association.](https://www.sutterhealth.org/research/publications/aha-consumer-use-mobile-health-cvd-prevention-1055312914) Burke LE, Ma J, Azar KM, Bennett GG, Peterson ED, Zheng Y, Riley W, Stephens J, Shah SH, Suffoletto B, Turan TN, Spring B, Steinberger J, Quinn CC. Circulation. pii: CIR.0000000000000232. \[Epub ahead of print\] 2015 Aug 13 - Publication ### [Under diagnosis of hypertension using electronic health records.](https://www.sutterhealth.org/research/publications/under-diagnosis-of-hypertension-using-ehr-1055312667) Banerjee D, Chung S, Wong EC, Wang EJ, Stafford RS, Palaniappan LP. Am J Manag Care. 16(2):e35-42 2010 Feb 01 - Publication ### [Machine learning and atherosclerotic cardiovascular disease risk prediction in a multi-ethnic population.](https://www.sutterhealth.org/research/publications/asvd-risk-prediction-in-multi-ethnic-population-1055312841) Ward A, Sarraju A, Chung S, Li J, Harrington R, Heidenreich P, Palaniappan L, Scheinker D, Rodriguez F. NPJ Digit Med. 3:125. doi: 10.1038/s41746-020-00331-1. eCollection 2020. 2020 Sep 23 - Publication ### [The human resource costs of implementing autopend clinical decision support to improve health maintenance.](https://www.sutterhealth.org/research/publications/hr-costs-to-implement-autopend-clinical-decision-support-1055312855) Panattoni L, Stults CD, Chan AS, Tai-Seale M. Am J Manag Care. 26(7):e232-e236. doi: 10.37765/ajmc.2020.43766. 2020 Jul 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/statin-use-and-ldl-in-statin-treated-patients-with-ascvd-1055312752#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Statin use and LDL in statin-treated patients with ASCVD."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/statin-use-and-ldl-in-statin-treated-patients-with-ascvd-1055312752#medicalscholarlyarticle","name":"Statin utilization and low-density lipoprotein cholesterol in statin-treated patients with atherosclerotic cardiovascular disease: trends from a community-based health care delivery system, 2002-2016.","headline":"Statin use and LDL in statin-treated patients with ASCVD.","abstract":"BACKGROUND: A better understanding of patterns in statin utilization and low-density lipoprotein cholesterol (LDL-C) among patients with atherosclerotic cardiovascular disease (ASCVD) in a clinical practice setting is needed. OBJECTIVES: The objective of this study was to examine statin utilization and LDL-C among new statin users with ASCVD. METHODS: This retrospective study used an electronic health record database from a community-based health care system. We identified ASCVD patients ≥21 years of age with a new statin prescription during the study period (2002-2016). Outcomes included high-intensity statin therapy (HIST) prescribing at treatment initiation, medication adherence (defined as proportion of days covered ≥0.80), statin therapy titrations rates, and changes in LDL-C during follow-up. RESULTS: Among 6199 eligible patients, mean follow-up was 16.8 months. At treatment initiation, 16.6% of patients received HIST. Approximately 53% of patients were adherent to statin regimens. Mean percent reduction in LDL-c was 25% during follow-up; 18% of patients, overall, and 30% of those initiating on HIST attained LDL-C reductions >50%. Rates of statin intensity-level increases were 8.4 per 100 person-years. HIST prescribing increased over time, beginning after generic atorvastatin availability and preceded treatment guidelines by two years. Initiation on HIST, higher adherence, and treatment intensification during follow-up were independent predictors of attaining LDL-C goals of \u003c70 mg/dL or \u003c100 mg/dL. CONCLUSIONS: In a community-based health care system, modest LDL-C lowering for secondary ASCVD prevention is likely driven by suboptimal adherence and low HIST prescribing and treatment intensification rates. Clinician and patient education are needed to reduce clinical inertia and improve medication adherence to better manage ASCVD.","description":"Modest LDL-C lowering for secondary ASCVD prevention is likely driven by suboptimal adherence and low high-intensity statin Rx's & low tx intensification rates.","keywords":["Cardiovascular Diseases","Medical Informatics","Prevention and Health Maintenance"],"datePublished":"2020-04-10","url":"https://www.sutterhealth.org/research/publications/statin-use-and-ldl-in-statin-treated-patients-with-ascvd-1055312752","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"32362513"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1016/j.jacl.2020.03.006"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/32362513/","https://doi.org/10.1016/j.jacl.2020.03.006"],"isPartOf":{"@type":"Periodical","name":"J Clin Lipidol"},"author":[{"@type":"Person","name":"Romanelli RJ"},{"@type":"Person","name":"Ito MK"},{"@type":"Person","name":"Karalis DG"},{"@type":"Person","name":"Huang HC"},{"@type":"Person","name":"Iorga SR"},{"@type":"Person","name":"Kam IW"},{"@type":"Person","name":"Thompson S"},{"@type":"Person","@id":"https://www.sutterhealth.org/research/investigators/kristen-m-j-azar-rn-msn-mph-1049680985","name":"Azar KMJ","url":"https://www.sutterhealth.org/research/investigators/kristen-m-j-azar-rn-msn-mph-1049680985"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Cardiovascular Diseases","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Cardiovascular+Diseases%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Medical Informatics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Medical+Informatics%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Prevention and Health Maintenance","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Prevention+and+Health+Maintenance%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/statin-use-and-ldl-in-statin-treated-patients-with-ascvd-1055312752","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/statin-use-and-ldl-in-statin-treated-patients-with-ascvd-1055312752#breadcrumblist"}}} ```