Abstract 13930: Three Out of Four High-risk Patients do not Attain LDL Cholesterol Goals: Insights From a Large U.S Managed Care Database
Background: The 2006 ACC/AHA Secondary Prevention Statement suggests treating high risk patients with coronary heart disease (CHD) or atherosclerotic vascular disease (AVD) to LDL-C <70 mg/dL is reasonable. This retrospective cross-sectional study examined trends in average LDL-C measures and goal attainment in high risk patients currently treated and untreated with lipid lowering therapy (LLT) in a U.S managed care database.
Methods: Patients diagnosed with CHD or AVD based on specified ICD-9 diagnostic codes with at least one LDL-C test from Jan 2004 to June 2012 were identified in the Optum Insight database. Patients were required to be ≥18 years old when the LDL-C test was taken and to be enrolled 90 days before and 30 days after the LDL-C measurement. Patients were identified as currently treated if they received an LLT within 90 days of the LDL-C measurement.
Results: The number of eligible patients ranged from 42,413 (2007) to 58,341 (2009). The percent of patients who were treated increased from 61.4% (2004) to 67.9% (2006) then remained relatively constant until 2012 (68.5%). Treated patients had higher prevalence of diabetes, revascularization and acute myocardial infarction. Mean LDL-C values in treated patients decreased sharply from 103.7 (Jan 2004) to 88.2 mg/dL (May 2012), while LDL-C decreased far less in untreated patients (118.7 to 109.2 mg/dL during this period). Among untreated patients, the percentage with LDL-C <70 mg/dL was relatively stable (6.0% in 2004 and 9.8% in 2012) while currently treated patients saw the percentage with LDL-C <70 mg/dL rise from 11.1% in 2004 to 28.6% in 2012.
Conclusion: While the proportion of LLT-treated high risk patients who achieve LDL-C <70 mg/dL levels has increased sharply since 2004, 3 out of 4 high risk patients still do not meet this goal (71.4%). Additionally, approximately 30% of high risk patients eligible for LLT remain untreated indicating the need for renewed efforts to support guideline-based LDL-C treatment.
- © 2013 by American Heart Association, Inc.