Impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on the prescription of high-intensity statins in patients hospitalized for acute coronary syndrome or stroke

详细信息    查看全文

• 作者：Michael Valentino ; MD ; PhD^a ; ¹ ; ^{Michael.Valentino@jefferson.edu" class="auth_mail" title="E-mail the corresponding author} ; Jad Al Danaf ; MD ; MPH^b ; ¹ ; Andrew Panakos ; MD^b ; Loheetha Ragupathi ; MD^b ; Danielle Duffy ; MD^a ; David Whellan ; MD ; MHS^a
• 刊名：American Heart Journal
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：181
• 期：Complete
• 页码：130-136
• 全文大小：227 K

文摘

The 2013 American College of Cardiology/American Heart Association cholesterol management guidelines represented a paradigm shift from the National Cholesterol Education Program Adult Treatment Panel III guidelines, replacing low-density lipoprotein cholesterol targets with a risk assessment model to guide statin therapy. Our objectives are to compare provider prescription of high-intensity statin therapy in patients hospitalized with acute coronary syndrome (ACS) or cerebrovascular accident (CVA) before and after the publication of the 2013 cholesterol guidelines, determine potential predictors of high-intensity statin utilization, and identify targets for improvement in cardiovascular risk reduction among these high-risk populations.

Methods

A single-center retrospective cohort study of 695 patients discharged with a diagnosis of ACS or CVA in the 6 months before (n = 359) and after (n = 336) the release of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines. Patient characteristics were compared using analysis of variance and χ² tests. Multivariable logistic regression models were used to assess clinical predictors of provider utilization of high-intensity statins.

Results

After the 2013 cholesterol guidelines, the rate of prescribing high-intensity statins was greater for statin-naïve patients compared with those already on statin therapy (odds ratio [OR] 0.51, P = .02). Prescription of high-intensity statins was higher for patients with ACS compared with CVA (OR 8.4, P < .001—pre-2013 guidelines; OR 4.5, P < .001—post-2013 guidelines). Prescription of high-intensity statins steadily improved over the study period, significantly among patients with CVA (P < .001).

Conclusions

Physicians were more likely to prescribe high-intensity statins in statin-naïve patients as compared with intensifying existing statin therapy, and their prescription pattern was lower after CVA vs ACS.