Abstract 134: Unmet Need in Hyperlipidemia

Background: Cardiovascular disease (CVD) remains the largest driver of mortality worldwide, with an annual global estimate of 20 million deaths by 2030. Lipid lowering therapies (LLT) including statins have become a mainstay of treatment for those at risk for CVD. Similarly, for approximately 20 years, treatment for those with atherosclerotic disease (ASVCD) has mainly involved the use of LLTs to lower levels of low density lipoprotein (LDL-C). Despite the widespread use of LLTs, it remains unclear whether greater intervention is required to reduce LDL-C to safe levels among those at high risk. Objectives: We examined the utilization patterns of LLTs between 2003-2012, and the proportion of LLT users with LDL<70 mg/dL among those in the 4 statin benefit groups defined by the American College of Cardiology and the American Heart Association (ACC/AHA). Methods: We used data from NHANES between 2003-2012 to assess trends in LLTs use and percent of users with LDL-C<70 mg/dL among adults ≥18 years old in the US population who met the criteria for the 4 statin benefits groups. We calculated frequencies, means, and percents that were weighted to obtain population estimates. We conducted linear trend tests to assess whether changes in estimates were statistically significant over time. Results: The number of adults ≥18 years old in the US who belonged to the 4 statin benefit groups increased from 57,260,635 (26.7%) in 2003-2004 to 64,479,875 (27.9%) in 2011-2012. The percent of adults in these 4 statin benefit groups who used LLTs increased from 30.8% to 47.1% (p<0.001) between 2003-2012. Among LLT users, the percent with LDL-C<70 mg/dL increased from 11.0% in 2003-2004 to 21.9% in 2011-2012 (p<0.001). In 2011-2012, the percent of LLT users with LDL-C <70 mg/dL in the 4 statin benefit groups ranged from 0% to 46%. Among people at highest risk (with ASCVD), 72.9% used LLTs in 2011-2012, and only 20% of these users had LDL-C<70 mg/dL. Conclusions: Despite an increase in the number of people considered at high risk by the ACC/AHA guidelines and the significant rise in LLT use between 2003-2012, the majority of LLT users have LDL-C levels over 70 mg/dL. Given the recent evidence that lower LDL-C levels confer the greatest decreases in risk of cardiac events, a significant unmet need exists for greater intervention in order to effectively decrease LDL-C to safe levels in the US adult population.