Two new studies based on data from the ACC’s outpatient PINNACLE Registry provide unique insights into the potential impacts of the new ACC/AHA cholesterol guidelines, as well as new recommendations for the management of hypertension. Both studies, presented as part of AHA 2014 and simultaneously published in the Journal of the American College of Cardiology, provide examples of how data from a large, contemporary clinical registry like PINNACLE can provide important, timely perspectives on current cardiovascular care in the U.S.

In the study assessing the impacts of the new cholesterol guidelines, investigators using registry data from 2008 to 2012 found significant gaps in secondary prevention for cardiac patients. The 2013 ACC/AHA cholesterol guidelines recommend fixed-dose statin therapy for at-risk patients, but do not recommend non-statin therapies or treatment to target low-density lipoprotein cholesterol (LDL-C) levels, limiting the need for repeated LDL-C testing.  However, according to PINNACLE Registry data, while the majority of patients qualified for statin therapy under the new guidelines, 32.4 percent were not receiving statin therapy. Study investigators also found that 22.6 percent of patients were receiving non-statin therapies. In addition, repeated LDL-C testing occurred in 20.8 percent of patients.

“Achieving concordance with the new cholesterol guidelines in patients treated in U.S. cardiovascular practices would result in significant increases in statin use, as well as significant reductions in non-statin therapies and laboratory testing,” study investigators said.

In terms of blood pressure management, a 2014 expert panel recommended increasing the blood pressure targets for patients aged 60 and older, as well as those with diabetes or chronic kidney disease. A study of PINNACLE Registry patients suggests that 14.6 percent who currently fail to meet 2003 guideline recommendations, would meet the new recommendations if they are allowed to move forward. These patients, according to study investigators, are at significantly higher cardiovascular risk than those meeting the 2003 guidelines. Specifically, the patients for whom the recommendations would change had an average 10-year risk of myocardial infarction or death of 8.5 percent.

“If the new recommendations are implemented in clinical practice, blood pressure target achievement and cardiovascular events will need careful monitoring, since many patients for whom the target blood pressure is now more permissive are at high cardiovascular risk,” the study investigators note.

In addition to these two studies, PINNACLE Registry data were highlighted in an AHA 2014 poster session on Sunday, Nov. 16 that looked at practice variation in antiplatelet and anticoagulation therapy for patients with both atrial fibrillation and coronary artery disease. PINNACLE Registry data also played a central role in an oral presentation on Wednesday, Nov. 19 that looked at provider type and quality of outpatient cardiovascular disease and the implications for the Affordable Care Act.

Keywords: Coronary Artery Disease, Myocardial Infarction, Cholesterol, LDL, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Atrial Fibrillation, Risk Factors, Blood Pressure, Patient Protection and Affordable Care Act, Hypertension, Diabetes Mellitus, Renal Insufficiency, Chronic, National Cardiovascular Data Registries, PINNACLE Registry

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