Abstract 19949: Attainment of Lipid Levels in Patients at High Cardiovascular Risk: Results from a U.S. Managed Care Population Study
Background: Current, generalizable data on low density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (non-HDL-C) as well as triglyceride (TG) levels are necessary to guide health policy decisions, guideline recommendations and treatment innovation. While LDL-C and non-HDL-C are established targets, TG elevations of 150-500 mg/dL and >500 mg/dL can contribute to CV disease and pancreatitis risk, respectively. We evaluated attainment of these lipid measures in a large, managed care population in the US.
Methods: The analysis included patients from the Optum Research Database meeting the following criteria: a valid lipid profile measurement in 2012 (i.e. “index date”); ≥20 years of age; continuous enrollment for≥ 2 years; and ≥1 high risk CV condition. Each patient was categorized into a mutually-exclusive category in the following hierarchy: acute coronary syndrome (ACS) within 12 months; stable coronary heart disease (CHD); ischemic stroke; peripheral arterial disease (PAD); and diabetes mellitus. Patients covered by a prescription on the index date or within 30 days were considered to be on treatment.
Results: In total, 217,516 patients met the inclusion criteria. Median (Q1 to Q3) age was 61 (53 to 70) years, 51.6% were male, 10.7% were treated with intensive statins, 34.8% with less-intensive statins and 5.8% with nonstatin lipid-modifying therapy. Median LDL-C was 92 (72 to 116) mg/dL, non-HDL-C was 118 (96 to 145) mg/dL and TG was 120 (85 to 169) mg/dL in the overall cohort. The frequency of lipid level achievement is displayed by hierarchical disease state (TABLE).
Conclusions: This study is the largest analysis of LDL-C, non-HDL-C and TG levels in a contemporary US managed care high risk population. Statins were underutilized, reflected by inadequate achievement of optimal LDL-C and non-HDL-C levels. While very high TG levels were infrequent, more optimal TG level were only achieved in about two-thirds of the population.
Author Disclosures: D. Steen: Consultant/Advisory Board; Modest; Regeneron. Consultant/Advisory Board; Significant; Sanofi. I. Khan: Employment; Significant; Sanofi. L.K. Becker: Employment; Significant; Employee of Optum, which is contracted with Sanofi for work on this study; employment is not conditional on work completed for Sanofi. K.M. Gorcyca: Employment; Significant; Sanofi. J. Foody: Consultant/Advisory Board; Modest; Sanofi, Merck, Pfizer, BMS, Regeneron, Aegerion.
- © 2014 by American Heart Association, Inc.