Evidence-based use of lipid-lowering therapy is low among patients whose low-density lipoprotein cholesterol (LDL-C) is greater than or equal to 190 mg/dL, with significant practice-level variations in care, according to a study published June 18 in Circulation: Cardiovascular Quality and Outcomes.

Salim S. Virani, MD, PhD, FACC, et al., identified 49,447 patients in ACC’s PINNACLE Registry with LDL-C ≥ 190 mg/dL taking a statin, high-intensity statin, lipid-lowering therapy associated with at least a 50 percent reduction in LDL-C, ezetimibe or PCSK9 inhibitor.

Results showed that among all patients, about four in 10 were not receiving any statin therapy and fewer than one-third were treated with high-intensity statins. There was also a 20 percent variation in the use of statins and 131 percent variation in the use of high-intensity statins for two similar patients treated at two random practices.

The researchers also note significant practice-level variations for each therapy. Median practice-level rates after adjusting for median rate ratio were 56 percent for any statin; 30.2 percent for high-intensity statins; 31.8 percent for lipid-lowering therapy with at least a 50 percent reduction in LDL-C; 5.8 percent for ezetimibe; and 0.16 percent for PCSK9 inhibitors. 

According to the authors, provider preference for lifestyle modification vs. statin therapy and a lack of knowledge among providers about different statin therapies could account for some of the variations. In addition, the authors note that difficulties related to prior authorization could account for the low percentage of patients on nonstatin therapies, particularly PCSK9 inhibitors. They conclude that moving forward, system-level interventions are necessary to address the significant treatment gaps and practice-level variations in the use of evidence-based lipid-lowering therapy.

Keywords: Cholesterol, LDL, Registries, Anticholesteremic Agents, Hypercholesterolemia, National Cardiovascular Data Registries, PINNACLE Registry

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