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. 2014 May-Jun;12(3):215-23.
doi: 10.1370/afm.1641.

Cardiovascular risk and statin use in the United States

Michael Edward Johansen  1 , Lee A Green, Ananda Sen, Sheetal Kircher, Caroline R Richardson
Affiliations

Cardiovascular risk and statin use in the United States

Michael Edward Johansen et al. Ann Fam Med. 2014 May-Jun.

Abstract

Purpose: Statins reduce the risk of mortality and coronary artery disease in individuals at high cardiovascular risk. Using nationally representative data, we examined the relationships between statin use and cardiovascular risk, diagnosis of hyperlipidemia, and other risk factors.

Methods: We analyzed data from the 2010 Medical Expenditure Panel Survey, a nationally representative survey of the U.S. civilian noninstitutionalized population. The study sample had a total of 16,712 individuals aged 30 to 79 years. Those who reported filling at least 2 statin prescriptions were classified as statin users. We created multiple logistic regression models for statin use as the dependent variable, with cardiovascular risk factors and sociodemographic factors as independent variables.

Results: Overall, 58.2% (95% CI, 54.6%-61.7%) of individuals with coronary artery disease and 52.0% (95% CI, 49.4%-54.6%) of individuals with diabetes aged older than 40 years were statin users. After adjusting for cardiovascular risk factors and sociodemographic factors, the probability of being on a statin was significantly higher among individuals with both hyperlipidemia and coronary artery disease, at 0.44 (95% CI, 0.40-0.48), or hyperlipidemia only, at 0.32 (95% CI, 0.30-0.33), than among those with coronary artery disease only, at 0.11 (95% CI, 0.07-0.15). A similar pattern was seen in people with diabetes.

Conclusions: In this nationally representative sample, many people at high risk for cardiovascular events, including those with coronary artery disease, diabetes, or both, were not receiving statins despite evidence that these agents reduce adverse events. This undertreatment appears to be related to placing too much emphasis on hyperlipidemia and not enough on cardiovascular risk. Recently released guidelines from the American College of Cardiology and the American Heart Association offer an opportunity to improve statin use by focusing on cardiovascular risk instead of lipid levels.

Keywords: cardiovascular: coronary artery disease; cardiovascular: hyperlipidemia; endocrinology: diabetes; primary care issues.

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Figures

Figure 1
Figure 1
Probability of statin use by presence of coronary artery disease, according to sex and presence of hyperlipidemia. CAD = coronary artery disease.
Figure 1
Figure 1
Probability of statin use by presence of coronary artery disease, according to sex and presence of hyperlipidemia. CAD = coronary artery disease.
Figure 1
Figure 1
Probability of statin use by presence of coronary artery disease, according to sex and presence of hyperlipidemia. CAD = coronary artery disease.
Figure 1
Figure 1
Probability of statin use by presence of coronary artery disease, according to sex and presence of hyperlipidemia. CAD = coronary artery disease.
Figure 2
Figure 2
Probability of statin use by presence of diabetes after age 40, according to sex and presence of hyperlipidemia.
Figure 2
Figure 2
Probability of statin use by presence of diabetes after age 40, according to sex and presence of hyperlipidemia.
Figure 2
Figure 2
Probability of statin use by presence of diabetes after age 40, according to sex and presence of hyperlipidemia.
Figure 2
Figure 2
Probability of statin use by presence of diabetes after age 40, according to sex and presence of hyperlipidemia.
Figure 3
Figure 3
Probability of statin use in an individual without diabetes or coronary artery disease by modified cardiovascular risk index, according to sex.
Figure 3
Figure 3
Probability of statin use in an individual without diabetes or coronary artery disease by modified cardiovascular risk index, according to sex.
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