Intensity of Lipid Lowering With Statin Therapy in Patients With Cerebrovascular Disease Versus Coronary Artery Disease: Insights from the PALM Registry

Ying Xian, Ann Marie Navar, Shuang Li, Zhuokai Li, Jennifer Robinson, Salim S. Virani, Michael J. Louie, Andrew Koren, Anne Goldberg, Veronique L. Roger, Peter W.F. Wilson, Eric D. Peterson, Tracy Y. Wang

Research output: Contribution to journalArticle

Abstract

Background Current treatment guidelines strongly recommend statin therapy for secondary prevention. However, it remains unclear whether patients' perceptions of cardiovascular risk, beliefs on cholesterol, or the intensity of prescribed statin therapy differs for patients with coronary artery disease (CAD) versus cerebrovascular disease (CeVD) versus both CAD and CeVD (CAD&CeVD). Methods and Results The PALM (Patient and Provider Assessment of Lipid Management) registry collected data on statin use, intensity, and core laboratory low-density lipoprotein cholesterol levels for 3232 secondary prevention patients treated at 133 US clinics. Among individuals with CeVD only (n=403), CAD only (n=2202), and CeVD&CAD (n=627), no significant differences were observed in patient-perceived cardiovascular disease risk, beliefs on cholesterol lowering, or perceived effectiveness and safety of statin therapy. However, patients with CeVD only were less likely to receive any statin therapy (76.2% versus 86.2%; adjusted odds ratio 0.64, 95% CI 0.45-0.91), or guideline-recommended statin intensity (34.6% versus 50.4%; adjusted odds ratio 0.60, 95% CI 0.45-0.81) than those with CAD only. Individuals with CeVD only were also less likely to achieve low-density lipoprotein cholesterol <100 mg/dL (59.2% versus 69.7%; adjusted odds ratio 0.79, 95% CI 0.64-0.99) than individuals with CAD alone. There were no significant differences in the use of any statin therapy or guideline-recommended statin intensity between individuals with CAD&CeVD and those with CAD only. Conclusions Despite lack of significant differences in patient-perceived cardiovascular risk or statin beliefs, patients with CeVD were significantly less likely to receive higher intensity statin or achieve low-density lipoprotein cholesterol <100 mg/dL than those with CAD only.

Original languageEnglish (US)
Pages (from-to)e013229
JournalJournal of the American Heart Association
Volume8
Issue number19
DOIs
StatePublished - Oct 1 2019

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Cerebrovascular Disorders
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Registries
Coronary Artery Disease
Lipids
LDL Cholesterol
Therapeutics
Odds Ratio
Guidelines
Secondary Prevention
Cholesterol
Cardiovascular Diseases
Safety

Keywords

  • coronary artery disease
  • quality of care
  • secondary prevention
  • statin
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Intensity of Lipid Lowering With Statin Therapy in Patients With Cerebrovascular Disease Versus Coronary Artery Disease : Insights from the PALM Registry. / Xian, Ying; Navar, Ann Marie; Li, Shuang; Li, Zhuokai; Robinson, Jennifer; Virani, Salim S.; Louie, Michael J.; Koren, Andrew; Goldberg, Anne; Roger, Veronique L.; Wilson, Peter W.F.; Peterson, Eric D.; Wang, Tracy Y.

In: Journal of the American Heart Association, Vol. 8, No. 19, 01.10.2019, p. e013229.

Research output: Contribution to journalArticle

Xian, Y, Navar, AM, Li, S, Li, Z, Robinson, J, Virani, SS, Louie, MJ, Koren, A, Goldberg, A, Roger, VL, Wilson, PWF, Peterson, ED & Wang, TY 2019, 'Intensity of Lipid Lowering With Statin Therapy in Patients With Cerebrovascular Disease Versus Coronary Artery Disease: Insights from the PALM Registry', Journal of the American Heart Association, vol. 8, no. 19, pp. e013229. https://doi.org/10.1161/JAHA.119.013229
Xian, Ying ; Navar, Ann Marie ; Li, Shuang ; Li, Zhuokai ; Robinson, Jennifer ; Virani, Salim S. ; Louie, Michael J. ; Koren, Andrew ; Goldberg, Anne ; Roger, Veronique L. ; Wilson, Peter W.F. ; Peterson, Eric D. ; Wang, Tracy Y. / Intensity of Lipid Lowering With Statin Therapy in Patients With Cerebrovascular Disease Versus Coronary Artery Disease : Insights from the PALM Registry. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 19. pp. e013229.
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title = "Intensity of Lipid Lowering With Statin Therapy in Patients With Cerebrovascular Disease Versus Coronary Artery Disease: Insights from the PALM Registry",
abstract = "Background Current treatment guidelines strongly recommend statin therapy for secondary prevention. However, it remains unclear whether patients' perceptions of cardiovascular risk, beliefs on cholesterol, or the intensity of prescribed statin therapy differs for patients with coronary artery disease (CAD) versus cerebrovascular disease (CeVD) versus both CAD and CeVD (CAD&CeVD). Methods and Results The PALM (Patient and Provider Assessment of Lipid Management) registry collected data on statin use, intensity, and core laboratory low-density lipoprotein cholesterol levels for 3232 secondary prevention patients treated at 133 US clinics. Among individuals with CeVD only (n=403), CAD only (n=2202), and CeVD&CAD (n=627), no significant differences were observed in patient-perceived cardiovascular disease risk, beliefs on cholesterol lowering, or perceived effectiveness and safety of statin therapy. However, patients with CeVD only were less likely to receive any statin therapy (76.2{\%} versus 86.2{\%}; adjusted odds ratio 0.64, 95{\%} CI 0.45-0.91), or guideline-recommended statin intensity (34.6{\%} versus 50.4{\%}; adjusted odds ratio 0.60, 95{\%} CI 0.45-0.81) than those with CAD only. Individuals with CeVD only were also less likely to achieve low-density lipoprotein cholesterol <100 mg/dL (59.2{\%} versus 69.7{\%}; adjusted odds ratio 0.79, 95{\%} CI 0.64-0.99) than individuals with CAD alone. There were no significant differences in the use of any statin therapy or guideline-recommended statin intensity between individuals with CAD&CeVD and those with CAD only. Conclusions Despite lack of significant differences in patient-perceived cardiovascular risk or statin beliefs, patients with CeVD were significantly less likely to receive higher intensity statin or achieve low-density lipoprotein cholesterol <100 mg/dL than those with CAD only.",
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author = "Ying Xian and Navar, {Ann Marie} and Shuang Li and Zhuokai Li and Jennifer Robinson and Virani, {Salim S.} and Louie, {Michael J.} and Andrew Koren and Anne Goldberg and Roger, {Veronique L.} and Wilson, {Peter W.F.} and Peterson, {Eric D.} and Wang, {Tracy Y.}",
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T1 - Intensity of Lipid Lowering With Statin Therapy in Patients With Cerebrovascular Disease Versus Coronary Artery Disease

T2 - Insights from the PALM Registry

AU - Xian, Ying

AU - Navar, Ann Marie

AU - Li, Shuang

AU - Li, Zhuokai

AU - Robinson, Jennifer

AU - Virani, Salim S.

AU - Louie, Michael J.

AU - Koren, Andrew

AU - Goldberg, Anne

AU - Roger, Veronique L.

AU - Wilson, Peter W.F.

AU - Peterson, Eric D.

AU - Wang, Tracy Y.

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N2 - Background Current treatment guidelines strongly recommend statin therapy for secondary prevention. However, it remains unclear whether patients' perceptions of cardiovascular risk, beliefs on cholesterol, or the intensity of prescribed statin therapy differs for patients with coronary artery disease (CAD) versus cerebrovascular disease (CeVD) versus both CAD and CeVD (CAD&CeVD). Methods and Results The PALM (Patient and Provider Assessment of Lipid Management) registry collected data on statin use, intensity, and core laboratory low-density lipoprotein cholesterol levels for 3232 secondary prevention patients treated at 133 US clinics. Among individuals with CeVD only (n=403), CAD only (n=2202), and CeVD&CAD (n=627), no significant differences were observed in patient-perceived cardiovascular disease risk, beliefs on cholesterol lowering, or perceived effectiveness and safety of statin therapy. However, patients with CeVD only were less likely to receive any statin therapy (76.2% versus 86.2%; adjusted odds ratio 0.64, 95% CI 0.45-0.91), or guideline-recommended statin intensity (34.6% versus 50.4%; adjusted odds ratio 0.60, 95% CI 0.45-0.81) than those with CAD only. Individuals with CeVD only were also less likely to achieve low-density lipoprotein cholesterol <100 mg/dL (59.2% versus 69.7%; adjusted odds ratio 0.79, 95% CI 0.64-0.99) than individuals with CAD alone. There were no significant differences in the use of any statin therapy or guideline-recommended statin intensity between individuals with CAD&CeVD and those with CAD only. Conclusions Despite lack of significant differences in patient-perceived cardiovascular risk or statin beliefs, patients with CeVD were significantly less likely to receive higher intensity statin or achieve low-density lipoprotein cholesterol <100 mg/dL than those with CAD only.

AB - Background Current treatment guidelines strongly recommend statin therapy for secondary prevention. However, it remains unclear whether patients' perceptions of cardiovascular risk, beliefs on cholesterol, or the intensity of prescribed statin therapy differs for patients with coronary artery disease (CAD) versus cerebrovascular disease (CeVD) versus both CAD and CeVD (CAD&CeVD). Methods and Results The PALM (Patient and Provider Assessment of Lipid Management) registry collected data on statin use, intensity, and core laboratory low-density lipoprotein cholesterol levels for 3232 secondary prevention patients treated at 133 US clinics. Among individuals with CeVD only (n=403), CAD only (n=2202), and CeVD&CAD (n=627), no significant differences were observed in patient-perceived cardiovascular disease risk, beliefs on cholesterol lowering, or perceived effectiveness and safety of statin therapy. However, patients with CeVD only were less likely to receive any statin therapy (76.2% versus 86.2%; adjusted odds ratio 0.64, 95% CI 0.45-0.91), or guideline-recommended statin intensity (34.6% versus 50.4%; adjusted odds ratio 0.60, 95% CI 0.45-0.81) than those with CAD only. Individuals with CeVD only were also less likely to achieve low-density lipoprotein cholesterol <100 mg/dL (59.2% versus 69.7%; adjusted odds ratio 0.79, 95% CI 0.64-0.99) than individuals with CAD alone. There were no significant differences in the use of any statin therapy or guideline-recommended statin intensity between individuals with CAD&CeVD and those with CAD only. Conclusions Despite lack of significant differences in patient-perceived cardiovascular risk or statin beliefs, patients with CeVD were significantly less likely to receive higher intensity statin or achieve low-density lipoprotein cholesterol <100 mg/dL than those with CAD only.

KW - coronary artery disease

KW - quality of care

KW - secondary prevention

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KW - stroke

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