Abstract 18064: Lipid Reduction Measurements in a Veteran Population - Implications for Genetic Modeling in the Million Veteran Program
Introduction: The 2013 ACC/AHA guidelines on the Treatment of Blood Cholesterol to Reduce Cardiovascular Risk presented a new statin algorithm to guide the selection of a statin agent and dosage based on desired patient low-density lipoprotein cholesterol (LDL-C) reduction. This algorithm was derived largely from randomized control trials (RCTs). The aim of our study was to evaluate the LDL-C reduction obtained from statin therapy in a real-world population setting for imputation in genetic analysis.
Hypothesis: The LDL-C reduction obtained from statin therapy in a real-world setting is less than that reported by RCTs.
Methods: Data for individuals in the VA New England Healthcare system who were on Simvastatin or Atorvastatin therapy and had at least 2 lipid measurements in blood available at least 3 months apart were analyzed. Prescription dosage and refill data were used to calculate average daily doses of statin therapy and generate a mixed model to estimate the percentage decrease in LDL-C (%LDL-C) per mg unit change in statin therapy. These estimates were used to extrapolate expected LDL-C reductions for standard doses of Simvastatin and Atorvastatin.
Results: A total of 244,244 veterans were assessed, 96% were male, 81% Caucasian, and the mean age was 62 (±16) years at baseline. Greater statin dosage (20, 40, 60, 80 mg/day) was associated with greater %LDL-C reductions with diminishing returns (-10, -17, -20, -19% decrease in LDL-C respectively, table 1).
Conclusions: Real world reduction of LDL-C in a VA population following statin initiation is much less than projected by the 2013 guidelines. Potential explanations for this include reduced adherence, inclusion of subjects with greater comorbidities, and clinician treatment to an LDL goal. Our findings have important implications in the appropriate adjustment of LDL levels for genetic association studies in the Million Veteran Program.
Author Disclosures: D. Klarin: None. Y. Ho: None. D.R. Gagnon: None. J. Honerlaw: None. J.L. Vassy: None. D. Voora: Research Grant; Significant; NIH, DoD, AstraZeneca. T. Assimes: None. D.J. Rader: Consultant/Advisory Board; Modest; Merck. W. Boden: None. S. Damrauer: None. P. Natarajan: None. S. Kathiresan: Employment; Modest; Regeneron, Merck, Celera, Novartis, Bristol-Myers Squibb, Sanofi, AstraZeneca, Alnylam, Eli Lilly, Leerink, Catabasis,. Research Grant; Significant; Regeneron, Bayer. Consultant/Advisory Board; Modest; Regeneron. C.J. O’Donnell: None. J. Gaziano: None. K. Cho: None. P.S. Tsao: None. P.W. Wilson: None.
- © 2016 by American Heart Association, Inc.