RT Journal Article
SR Electronic
T1 Cardiovascular Risk and Statin Use in the United States
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 215
OP 223
DO 10.1370/afm.1641
VO 12
IS 3
A1 Michael Edward Johansen
A1 Lee A. Green
A1 Ananda Sen
A1 Sheetal Kircher
A1 Caroline R. Richardson
YR 2014
UL http://www.annfammed.org/content/12/3/215.abstract
AB 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 US 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.