Abstract 19779: Effect of 2013 ACC/AHA Blood Cholesterol Guidelines on Statin Treatment Patterns and Low Density Lipoprotein Cholesterol (LDL-C) Levels in Patients With Atherosclerotic Cardiovascular Disease (ASCVD)

Introduction: Prior to the 2013 ACC/AHA Blood Cholesterol Guidelines, prescribers aimed for an LDL-C target of 70 or 100 mg/dL in patients with ASCVD. The focus in the 2013 guidelines is on treating patients with the appropriate statin intensity. Few studies have examined real world data on statin use and LDL-C results before and after the 2013 guidelines. Objective: To examine statin use and LDL-C results before and after the 2013 guidelines in patients with clinical ASCVD as defined in 2013 ACC/AHA Guidelines. Methods: This is a retrospective cohort study of adult (21+) commercial and Medicare Advantage health plan enrollees in the Optum® Research Database. Subjects had ≥1 claim with a diagnosis of clinical ASCVD between 11/1/2012 and 12/31/2014, and were continuously enrolled 6 months before (baseline) and 7 months after (follow up) their first ASCVD visit. Subjects had at least one follow up LDL-C assessment and were assigned to monthly cohorts based on the month of their ASCVD event. Statin use and intensity were measured during baseline and the first month of follow up. LDL-C was assessed during follow up months 2-7. Results: The sample included 90,369 subjects across 26 monthly cohorts. Mean age was 68 years, 50% were female, and 31% had commercial insurance. Statin use during the first month after an ASCVD visit remained consistent before and after guidelines, 32% and 31%. Of patients receiving statins, high intensity statin use increased from 26.6% pre- to 30.6% post-guidelines. Mean LDL-C were similar pre- and post-guideline change (93.9 mg/dL and 94.3 mg/dL). Conclusions: Statin use and monthly mean LDL-C one year before and after the guidelines remained largely unchanged. However, the proportion of patients with ASCVD receiving high intensity statins increased slightly. More effort may be needed to increase guideline adherence and dissemination to help improve treatment for this high risk population.