Abstract 18274: Under Use of Statins and LDL-C Control Among People With a Framingham 10-Year Coronary Heart Disease Risk > 20%
Statins reduce the incidence of coronary heart disease (CHD) in individuals with a history of CHD or risk equivalents. A 10-year CHD risk >20% is considered a CHD risk equivalent but is frequently not estimated. We studied the use of statins and control of LDL-C among participants with a history of CHD or CHD risk equivalents in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=30,239) The 8,812 participants with CHD or risk equivalents were categorized into four mutually exclusive groups: (1) history of CHD, (2) no history of CHD but with a history of stroke and/or aortic aneurysm, (3) no history of CHD, stroke or aortic aneurysm but with diabetes mellitus, or (4) no history of the conditions listed in (1) through (3) but with a Framingham 10-year CHD risk > 20% at baseline. Lipids were measured after an overnight fast, LDL-C was calculated using the Friedewald equation, and statin use was assessed through pill bottle review during an in-home study visit. The mean age of study participants was 65 years (SD=9), 45% were women and 46% were black. In fully adjusted models, compared to those with a history of CHD, the use of statins was statistically significantly lower among people with a history of stroke/aortic aneurysm, history of diabetes, and especially 10-year CHD risk > 20% (Table). Among high risk participants taking statins, the prevalence of LDL-C < 100 mg/dL was similar for those with a history of CHD, a history of stroke/aortic aneurysm and diabetes, but participants with a 10-year CHD risk > 20% were less likely to have an LDL-C < 100 mg/dL. These data suggest many people with high CHD risk, especially those with a FRS >20%, were not receiving guideline-concordant lipid-lowering therapy and quality improvement efforts should focus on this group.
- © 2013 by American Heart Association, Inc.