Statin use in outpatients with obstructive coronary artery disease

Suzanne V. Arnold, John A. Spertus, Fengming Tang, Harlan M. Krumholz, William B. Borden, Steven A. Farmer, Henry H. Ting, Paul S. Chan

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background-Clinical trials have shown that statin therapy reduces cardiovascular morbidity and mortality in patients with coronary artery disease (CAD), even among patients with low-density lipoprotein cholesterol levels <100 mg/dL. We sought to determine the extent to which patients with obstructive CAD in routine outpatient care are treated with statins, nonstatins, or no lipid-lowering therapy. Methods and Results-Within the American College of Cardiology's Practice Innovation and Clinical Excellence (PINNACLE) outpatient registry, we examined rates of treatment with statin and nonstatin medications in 38 775 outpatients with obstructive CAD (history of myocardial infarction or coronary revascularization) and without documented contraindications to statin therapy. Among these patients, 30 160 (77.8%) were prescribed statins, 2042 (5.3%) were treated only with nonstatin lipid-lowering medications, and 6573 (17.0%) were untreated. Lack of medical insurance was associated with no statin treatment, and 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 levels were available for 51.2% (3365/6573). Among these untreated patients, low-density lipoprotein cholesterol levels were <100 mg/dL in 1794 patients (53.3%) and 100 mg/dL in 1571 patients (46.7%). Conclusions-Despite robust clinical trial evidence, a substantial number of patients with obstructive CAD remain untreated with statins. A small proportion were treated with nonstatin therapy, and 1 in 6 patients was simply untreated; half of the untreated patients had low-density lipoprotein cholesterol values <100 mg/dL. These findings illustrate important opportunities to improve lipid management in outpatients with obstructive CAD.

Original languageEnglish (US)
Pages (from-to)2405-2410
Number of pages6
JournalCirculation
Volume124
Issue number22
DOIs
StatePublished - Nov 29 2011

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Coronary Artery Disease
Outpatients
LDL Cholesterol
Lipids
Therapeutics
Clinical Trials
Ambulatory Care
Insurance
Cardiology
Registries
Myocardial Infarction
Hypertension
Morbidity

Keywords

  • cholesterol reduction
  • coronary artery disease
  • lipids
  • statins

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Arnold, S. V., Spertus, J. A., Tang, F., Krumholz, H. M., Borden, W. B., Farmer, S. A., ... Chan, P. S. (2011). Statin use in outpatients with obstructive coronary artery disease. Circulation, 124(22), 2405-2410. https://doi.org/10.1161/CIRCULATIONAHA.111.038265

Statin use in outpatients with obstructive coronary artery disease. / Arnold, Suzanne V.; Spertus, John A.; Tang, Fengming; Krumholz, Harlan M.; Borden, William B.; Farmer, Steven A.; Ting, Henry H.; Chan, Paul S.

In: Circulation, Vol. 124, No. 22, 29.11.2011, p. 2405-2410.

Research output: Contribution to journalArticle

Arnold, SV, Spertus, JA, Tang, F, Krumholz, HM, Borden, WB, Farmer, SA, Ting, HH & Chan, PS 2011, 'Statin use in outpatients with obstructive coronary artery disease', Circulation, vol. 124, no. 22, pp. 2405-2410. https://doi.org/10.1161/CIRCULATIONAHA.111.038265
Arnold SV, Spertus JA, Tang F, Krumholz HM, Borden WB, Farmer SA et al. Statin use in outpatients with obstructive coronary artery disease. Circulation. 2011 Nov 29;124(22):2405-2410. https://doi.org/10.1161/CIRCULATIONAHA.111.038265
Arnold, Suzanne V. ; Spertus, John A. ; Tang, Fengming ; Krumholz, Harlan M. ; Borden, William B. ; Farmer, Steven A. ; Ting, Henry H. ; Chan, Paul S. / Statin use in outpatients with obstructive coronary artery disease. In: Circulation. 2011 ; Vol. 124, No. 22. pp. 2405-2410.
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abstract = "Background-Clinical trials have shown that statin therapy reduces cardiovascular morbidity and mortality in patients with coronary artery disease (CAD), even among patients with low-density lipoprotein cholesterol levels <100 mg/dL. We sought to determine the extent to which patients with obstructive CAD in routine outpatient care are treated with statins, nonstatins, or no lipid-lowering therapy. Methods and Results-Within the American College of Cardiology's Practice Innovation and Clinical Excellence (PINNACLE) outpatient registry, we examined rates of treatment with statin and nonstatin medications in 38 775 outpatients with obstructive CAD (history of myocardial infarction or coronary revascularization) and without documented contraindications to statin therapy. Among these patients, 30 160 (77.8{\%}) were prescribed statins, 2042 (5.3{\%}) were treated only with nonstatin lipid-lowering medications, and 6573 (17.0{\%}) were untreated. Lack of medical insurance was associated with no statin treatment, and 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 levels were available for 51.2{\%} (3365/6573). Among these untreated patients, low-density lipoprotein cholesterol levels were <100 mg/dL in 1794 patients (53.3{\%}) and 100 mg/dL in 1571 patients (46.7{\%}). Conclusions-Despite robust clinical trial evidence, a substantial number of patients with obstructive CAD remain untreated with statins. A small proportion were treated with nonstatin therapy, and 1 in 6 patients was simply untreated; half of the untreated patients had low-density lipoprotein cholesterol values <100 mg/dL. These findings illustrate important opportunities to improve lipid management in outpatients with obstructive CAD.",
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AU - Farmer, Steven A.

AU - Ting, Henry H.

AU - Chan, Paul S.

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N2 - Background-Clinical trials have shown that statin therapy reduces cardiovascular morbidity and mortality in patients with coronary artery disease (CAD), even among patients with low-density lipoprotein cholesterol levels <100 mg/dL. We sought to determine the extent to which patients with obstructive CAD in routine outpatient care are treated with statins, nonstatins, or no lipid-lowering therapy. Methods and Results-Within the American College of Cardiology's Practice Innovation and Clinical Excellence (PINNACLE) outpatient registry, we examined rates of treatment with statin and nonstatin medications in 38 775 outpatients with obstructive CAD (history of myocardial infarction or coronary revascularization) and without documented contraindications to statin therapy. Among these patients, 30 160 (77.8%) were prescribed statins, 2042 (5.3%) were treated only with nonstatin lipid-lowering medications, and 6573 (17.0%) were untreated. Lack of medical insurance was associated with no statin treatment, and 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 levels were available for 51.2% (3365/6573). Among these untreated patients, low-density lipoprotein cholesterol levels were <100 mg/dL in 1794 patients (53.3%) and 100 mg/dL in 1571 patients (46.7%). Conclusions-Despite robust clinical trial evidence, a substantial number of patients with obstructive CAD remain untreated with statins. A small proportion were treated with nonstatin therapy, and 1 in 6 patients was simply untreated; half of the untreated patients had low-density lipoprotein cholesterol values <100 mg/dL. These findings illustrate important opportunities to improve lipid management in outpatients with obstructive CAD.

AB - Background-Clinical trials have shown that statin therapy reduces cardiovascular morbidity and mortality in patients with coronary artery disease (CAD), even among patients with low-density lipoprotein cholesterol levels <100 mg/dL. We sought to determine the extent to which patients with obstructive CAD in routine outpatient care are treated with statins, nonstatins, or no lipid-lowering therapy. Methods and Results-Within the American College of Cardiology's Practice Innovation and Clinical Excellence (PINNACLE) outpatient registry, we examined rates of treatment with statin and nonstatin medications in 38 775 outpatients with obstructive CAD (history of myocardial infarction or coronary revascularization) and without documented contraindications to statin therapy. Among these patients, 30 160 (77.8%) were prescribed statins, 2042 (5.3%) were treated only with nonstatin lipid-lowering medications, and 6573 (17.0%) were untreated. Lack of medical insurance was associated with no statin treatment, and 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 levels were available for 51.2% (3365/6573). Among these untreated patients, low-density lipoprotein cholesterol levels were <100 mg/dL in 1794 patients (53.3%) and 100 mg/dL in 1571 patients (46.7%). Conclusions-Despite robust clinical trial evidence, a substantial number of patients with obstructive CAD remain untreated with statins. A small proportion were treated with nonstatin therapy, and 1 in 6 patients was simply untreated; half of the untreated patients had low-density lipoprotein cholesterol values <100 mg/dL. These findings illustrate important opportunities to improve lipid management in outpatients with obstructive CAD.

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