Lipid management in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry

Ann Marie Navar, Tracy Y. Wang, Shuang Li, Jennifer G. Robinson, Anne C. Goldberg, Salim Virani, Veronique Lee Roger, Peter W.F. Wilson, Joseph Elassal, L. Veronica Lee, Eric D. Peterson

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDL-C) targets toward statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk. Methods Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary prevention patients from 138 PALM Registry practices. Results Overall, 74.7% of eligible adults were on statins; only 42.4% were on guideline-recommended intensity. Relative to primary prevention patients, ASCVD patients were more likely to be on a statin (83.6% vs 63.4%, P <.0001) and guideline-recommended intensity (47.3% vs 36.0%, P <.0001). Men were more likely than women to be prescribed recommended intensity for primary (odds ratio [OR] 1.87, 95% CI 1.49-2.34) and secondary (OR 1.47, 95% CI 1.26-1.70) prevention. In primary prevention, increasing age, diabetes, obesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients (OR 1.71, 95% CI 1.41-2.09), as were those seen by cardiologists (OR 1.43, 95% CI 1.12-1.83). Median LDL-C levels were highest among patients not on statins (124.0 mg/dL) and slightly higher among those on lower-than-recommended intensity compared with recommended-therapy recipients (88.0 and 84.0 mg/dL, respectively; P ≤.0001). Conclusions In routine contemporary practice, 1 in 4 guideline-eligible patients was not on a statin; less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment.

Original languageEnglish (US)
Pages (from-to)84-92
Number of pages9
JournalAmerican Heart Journal
Volume193
DOIs
StatePublished - Nov 1 2017

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Registries
Lipids
Guidelines
Cardiovascular Diseases
Primary Prevention
Odds Ratio
LDL Cholesterol
Peripheral Vascular Diseases
Practice Management
Secondary Prevention
HDL Cholesterol
Coronary Artery Disease
Obesity
Cholesterol
Hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Lipid management in contemporary community practice : Results from the Provider Assessment of Lipid Management (PALM) Registry. / Navar, Ann Marie; Wang, Tracy Y.; Li, Shuang; Robinson, Jennifer G.; Goldberg, Anne C.; Virani, Salim; Roger, Veronique Lee; Wilson, Peter W.F.; Elassal, Joseph; Lee, L. Veronica; Peterson, Eric D.

In: American Heart Journal, Vol. 193, 01.11.2017, p. 84-92.

Research output: Contribution to journalArticle

Navar, AM, Wang, TY, Li, S, Robinson, JG, Goldberg, AC, Virani, S, Roger, VL, Wilson, PWF, Elassal, J, Lee, LV & Peterson, ED 2017, 'Lipid management in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry', American Heart Journal, vol. 193, pp. 84-92. https://doi.org/10.1016/j.ahj.2017.08.005
Navar, Ann Marie ; Wang, Tracy Y. ; Li, Shuang ; Robinson, Jennifer G. ; Goldberg, Anne C. ; Virani, Salim ; Roger, Veronique Lee ; Wilson, Peter W.F. ; Elassal, Joseph ; Lee, L. Veronica ; Peterson, Eric D. / Lipid management in contemporary community practice : Results from the Provider Assessment of Lipid Management (PALM) Registry. In: American Heart Journal. 2017 ; Vol. 193. pp. 84-92.
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abstract = "Background The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDL-C) targets toward statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk. Methods Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary prevention patients from 138 PALM Registry practices. Results Overall, 74.7{\%} of eligible adults were on statins; only 42.4{\%} were on guideline-recommended intensity. Relative to primary prevention patients, ASCVD patients were more likely to be on a statin (83.6{\%} vs 63.4{\%}, P <.0001) and guideline-recommended intensity (47.3{\%} vs 36.0{\%}, P <.0001). Men were more likely than women to be prescribed recommended intensity for primary (odds ratio [OR] 1.87, 95{\%} CI 1.49-2.34) and secondary (OR 1.47, 95{\%} CI 1.26-1.70) prevention. In primary prevention, increasing age, diabetes, obesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients (OR 1.71, 95{\%} CI 1.41-2.09), as were those seen by cardiologists (OR 1.43, 95{\%} CI 1.12-1.83). Median LDL-C levels were highest among patients not on statins (124.0 mg/dL) and slightly higher among those on lower-than-recommended intensity compared with recommended-therapy recipients (88.0 and 84.0 mg/dL, respectively; P ≤.0001). Conclusions In routine contemporary practice, 1 in 4 guideline-eligible patients was not on a statin; less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment.",
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T2 - Results from the Provider Assessment of Lipid Management (PALM) Registry

AU - Navar, Ann Marie

AU - Wang, Tracy Y.

AU - Li, Shuang

AU - Robinson, Jennifer G.

AU - Goldberg, Anne C.

AU - Virani, Salim

AU - Roger, Veronique Lee

AU - Wilson, Peter W.F.

AU - Elassal, Joseph

AU - Lee, L. Veronica

AU - Peterson, Eric D.

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N2 - Background The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDL-C) targets toward statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk. Methods Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary prevention patients from 138 PALM Registry practices. Results Overall, 74.7% of eligible adults were on statins; only 42.4% were on guideline-recommended intensity. Relative to primary prevention patients, ASCVD patients were more likely to be on a statin (83.6% vs 63.4%, P <.0001) and guideline-recommended intensity (47.3% vs 36.0%, P <.0001). Men were more likely than women to be prescribed recommended intensity for primary (odds ratio [OR] 1.87, 95% CI 1.49-2.34) and secondary (OR 1.47, 95% CI 1.26-1.70) prevention. In primary prevention, increasing age, diabetes, obesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients (OR 1.71, 95% CI 1.41-2.09), as were those seen by cardiologists (OR 1.43, 95% CI 1.12-1.83). Median LDL-C levels were highest among patients not on statins (124.0 mg/dL) and slightly higher among those on lower-than-recommended intensity compared with recommended-therapy recipients (88.0 and 84.0 mg/dL, respectively; P ≤.0001). Conclusions In routine contemporary practice, 1 in 4 guideline-eligible patients was not on a statin; less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment.

AB - Background The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDL-C) targets toward statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk. Methods Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary prevention patients from 138 PALM Registry practices. Results Overall, 74.7% of eligible adults were on statins; only 42.4% were on guideline-recommended intensity. Relative to primary prevention patients, ASCVD patients were more likely to be on a statin (83.6% vs 63.4%, P <.0001) and guideline-recommended intensity (47.3% vs 36.0%, P <.0001). Men were more likely than women to be prescribed recommended intensity for primary (odds ratio [OR] 1.87, 95% CI 1.49-2.34) and secondary (OR 1.47, 95% CI 1.26-1.70) prevention. In primary prevention, increasing age, diabetes, obesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients (OR 1.71, 95% CI 1.41-2.09), as were those seen by cardiologists (OR 1.43, 95% CI 1.12-1.83). Median LDL-C levels were highest among patients not on statins (124.0 mg/dL) and slightly higher among those on lower-than-recommended intensity compared with recommended-therapy recipients (88.0 and 84.0 mg/dL, respectively; P ≤.0001). Conclusions In routine contemporary practice, 1 in 4 guideline-eligible patients was not on a statin; less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment.

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