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Statin Use in Outpatients With Obstructive Coronary Artery Disease
Study Questions:
What is the frequency of which patients with obstructive coronary artery disease (CAD) in routine outpatient care are treated with statins, nonstatins, or no lipid-lowering therapy?
Methods:
The authors examined rates of treatment with statin and nonstatin medications in outpatients with obstructive CAD (history of myocardial infarction or coronary revascularization) and without documented contraindications to statin therapy. Patients were enrolled in the American College of Cardiology’s Practice Innovation and Clinical Excellence (PINNACLE) outpatient registry.
Results:
Average age was 67.5 years, and 6.2% had no health insurance. Among the 38,775 patients, 30,160 (77.8%) were prescribed statins, 2,042 (5.3%) were treated only with nonstatin lipid-lowering medications, and 6,573 (17.0%) were untreated. Lack of medical insurance was associated with no statin treatment. Male sex, coexisting hypertension, and a recent coronary revascularization were associated with statin treatment. Among those not on any lipid-lowering therapy, low-density lipoprotein cholesterol (LDL-C) levels were available for 51.2% (3,365/6,573). Among these untreated patients, LDL-C levels were <100 mg/dl in 1,794 patients (53.3%) and ≥100 mg/dl in 1,571 patients (46.7%).
Conclusions:
In patients with obstructive CAD, one in six were not treated with lipid-lowering medication; one-half of the untreated patients had LDL-C values <100 mg/dl. These findings illustrate important opportunities to improve lipid management in outpatients with obstructive CAD.
Perspective:
The findings are disappointing and surprising, considering the study period was between July 1, 2009, and June 30, 2010 and included 30 cardiology practices in which physicians were aware of the monitoring process with the intention of improving care. The frequency of failure to document statin intolerance could account for a significant percentage of nonstatin use.
Keywords: Coronary Artery Disease, Outpatients, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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