Abstract 18904: VARSITY Study (VA Retrospective study of Statin IntensiTY): Utilizing a Large VA Cohort to Determine the Actual Clinical Response of LDL Reduction After Initiating Statin Therapy in Newly Diagnosed ASCVD
Background: According to the 2013 ACC/AHA Blood Cholesterol Guideline (BCGL), high-intensity statin therapy (HIST) is recommended in individuals with newly diagnosed atherosclerotic cardiovascular disease (ASCVD) and this therapy is expected to lower LDL by >50%. These recommendations come from multiple studies which demonstrated that the reduction in major vascular events was proportional to the absolute LDL reduction. This retrospective study utilized a large VA cohort to report the LDL reduction with the initiation of statin therapy after an initial diagnosis of ASCVD.
Methods: A national cohort of VA patients with a new diagnosis of ASCVD and subsequent initiation of statin therapy was constructed. The most proximate LDL measured within 12 weeks before (PreLDL) and 4-12 weeks after (PostLDL) initiation of statin therapy were recorded. Patients with a prior diagnosis of ASCVD, a prior prescription for any lipid lowering drug, or a prior prescription for immunosuppressant agents were excluded. The statin doses were categorized as high-, moderate- or low-intensity as defined in the 2013 BCGL.
Results: This cohort consisted of 92,755 VA patients with an initial ASCVD diagnosis from 5/1992 to 7/2014. The cohort was 97% male, 19% ethnic minority, and the average age was 66.7 (± 10.9) years. The average PreLDL was 129.8 (±35.1), the average PostLDL was 94.2 (±31.7) mg/dl, and only 2.5% were prescribed HIST. The results are summarized in Table 1.
Conclusion: This cohort study examined statin intensity and LDL reduction after the initial diagnosis of ASCVD. HIST was rarely prescribed as initial therapy and in a majority of these patients the expected >50% LDL reduction was not achieved. This study suggests the need for additional research to explore the factors contributing to a >50% reduction in LDL following the initiation of statin therapy in patients with ASCVD, and that the monitoring of response to HIST may be clinically important.
Author Disclosures: M. Garcia: None. A. Murata: None. G. Charlton: None.
- © 2015 by American Heart Association, Inc.