Many Eligible Groups Not Receiving Recommended Statin Therapy Interview with:
Dr. Yashashwi Pokharel MD, MSCR
Department of Cardiovascular Research
Saint Luke’s Mid-America Heart Institute
Kansas City, Missouri and
Salim S. Virani, MD PhD, FACC, FAHA
Associate Professor, Section of Cardiovascular Research
Associate Director for Research, Cardiology Fellowship Training Program
Baylor College of Medicine
Investigator, Health Policy, Quality and Informatics Program
Michael E. DeBakey Veterans Affairs Medical Center HSR&D Center of Innovation
Staff Cardiologist, Michael E. DeBakey Veterans Affairs Medical Center
Houston, TX What is the background for this study? What are the main findings?

Response: Unlike the previous cholesterol management guideline that recommended use of either statin and non-statin therapy to achieve low density lipoprotein cholesterol (LDL-C) target, the 2013 American College of Cardiology/American Heart Association cholesterol management guideline made a major paradigm shift by recommending statin focused treatment in 4 specific patient groups and replaced LDL-C target with fixed statin intensity treatment (moderate to high intensity statin therapy).

With this change, it was speculated that a large number of patients would be eligible for statin treatment (in one study, up to 11.1% additional patients were expected to be eligible for statin therapy). Our study provided the real world trends in the use of statin and non-statin lipid lowering therapy (LLT) from a national sample of cardiology practices in 1.1 million patients 14 months before and 14 months after the release of the 2013 guideline.

We found a modest, but significant increasing trend in the use of statin therapy in only 1 of the 4 patient groups eligible for statin therapy (i.e., 4.3% increase in the use of moderate to high intensity statin therapy in patients with established atherosclerotic cardiovascular disease). We did not find any significant change in non-statin LLT use. Importantly, about a third to half of patients in statin eligible groups were not receiving moderate to high intensity statin therapy even after the publication of the 2013 guideline. What should readers take away from your report?

Response: Despite the proven benefit of statin therapy in prevention of atherosclerotic cardiovascular disease, current use of guideline recommended statin therapy remains low. What recommendations do you have for future research as a result of this study?

Response: To improve evidence based practice, it is important to understand barriers to use of statin therapy so that timely interventions can improve guideline concordant practice. Is there anything else you would like to add?

Response: Measures, such as educational activities focused on clarifying the recommendations of the 2013 guideline, audit and feedback, and quality improvement initiatives to understand and improve practice culture could possibly increase guideline concordant statin prescribing.


Dr. Pokharel is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health, Award Number T32HL110837. Dr. Nambi has received research grant from Merck (Paid to institution and not individual). He serves as a consultant/advisory board for Sanofi Regeneron, and has a provisional patent (# 61721475) entitled “Biomarkers to Improve Prediction of Heart Failure Risk” filed by Baylor College of Medicine, Roche. Dr. Bittner serves on a steering committee for ODYSSEY trial (Sanofi-Regeneron) and CETP inhibitor (Eli Lilly), as a national coordinator for STRENGTH Trial (Astra Zeneca),on an advisory boards (Eli Lilly and Amgen), is a co-investigator on a University of Alabama School of Public Health – Amgen contract relating to Medicare analyses, and is a past local site principal investigator for a Pfizer SPIRE trial (Paid to institution and not individual). Dr. Chan is supported by RO1 grant from the National Heart, Lung, and Blood Institute (1R01HL123980). Dr. Borden provides consulting to the Agency for Healthcare Research and Quality to support evidence-based cardiovascular disease prevention. Dr. Spertus has a contract to analyze data from the National Cardiovascular Data Registry. Dr. Petersen is supported by the Department of Veterans Affairs Health Services Research and Development Service (HSR&D). Ballantyne has received grant/research Support from Abbott Diagnostic, Amarin, Amgen, Eli Lilly, Esperion, Novartis, Pfizer, Otsuka, Regeneron, Roche Diagnostic, Sanofi-Synthelabo, Takeda, NIH, AHA, ADA; serves as a consultant to Abbott Diagnostics, Amarin, Amgen, Astra Zeneca, Eli Lilly, Esperion, Genzyme, Isis, Matinas BioPharma Inc, Merck, Novartis, Pfizer*, Regeneron, Roche, Sanofi-Synthelabo (Paid to institution and not individual). Dr. Virani is supported by the Department of Veterans Affairs Health Services Research and Development Service (HSR&D), American Heart Association Beginning-Grant-in-Aid, the American Diabetes Association Clinical Science and Epidemiology Award, and Baylor College of Medicine’s Global Initiatives (Paid to institution and not individual). He serves on the steering committee (no financial remuneration) for the Patient and Provider Assessment of Lipid Management (PALM) Registry at the Duke Clinical Research Institute. Other authors report no relevant disclosures. Thank you for your contribution to the community.

Adoption of the 2013 American College of Cardiology/ American Heart Association Cholesterol Management Guideline in Cardiology Practices Nationwide Yashashwi Pokharel, MD, MSCR; Fengming Tang, MS; Philip G. Jones, MS; Vijay Nambi, MD, PhD; Vera A. Bittner, MD, MSPH; Ravi S. Hira, MD; Khurram Nasir, MD, MPH; Paul S. Chan, MD, MSc; Thomas M. Maddox, MD, MSc; William J. Oetgen, MD, MBA; Paul A. Heidenreich, MD, MS; William B. Borden, MD, MBA; John A. Spertus, MD, MPH; Laura A. Petersen, MD, MPH; Christie M. Ballantyne, MD; Salim S. Virani, MD, PhD
JAMA Cardiology Published online March 1, 2017

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on March 2, 2017 by Marie Benz MD FAAD