Real-world prescribing in accordance to ACC/AHA guidelines for lipid-lowering therapy in high-risk primary and secondary prevention of ASCVD
Objective: The value of lipid lowering therapy (LLT) for prevention of atherosclerotic cardiovascular disease (ASCVD) is well understood. American College of Cardiology and American Heart Association guidelines recommend statin therapy for secondary and high-risk primary ASCVD prevention. Prior stud...
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Elsevier
2025-09-01
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| Series: | American Journal of Preventive Cardiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666667725001424 |
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| author | Jonathan Arnold Deeksha Acharya Hetal Boricha Himal Chapagain Aleesha Kainat Allison Bradley Jong-Hyeon Jeong Kevin A. Townsend Mohammad B. Ateya David A. DeMicco YousefAlish Michael J. Becich Cynthia H. Chuang Soledad A. Fernandez Daniel E. Ford Wenke Hwang H. Lester Kirchner Richard Morgan Anuradha Paranjape Neena A. Thomas David A. Williams RozelleHegeman-Dingle Euan McLeod Phillip A. Saccone Kathleen M. McTigue |
| author_facet | Jonathan Arnold Deeksha Acharya Hetal Boricha Himal Chapagain Aleesha Kainat Allison Bradley Jong-Hyeon Jeong Kevin A. Townsend Mohammad B. Ateya David A. DeMicco YousefAlish Michael J. Becich Cynthia H. Chuang Soledad A. Fernandez Daniel E. Ford Wenke Hwang H. Lester Kirchner Richard Morgan Anuradha Paranjape Neena A. Thomas David A. Williams RozelleHegeman-Dingle Euan McLeod Phillip A. Saccone Kathleen M. McTigue |
| author_sort | Jonathan Arnold |
| collection | DOAJ |
| description | Objective: The value of lipid lowering therapy (LLT) for prevention of atherosclerotic cardiovascular disease (ASCVD) is well understood. American College of Cardiology and American Heart Association guidelines recommend statin therapy for secondary and high-risk primary ASCVD prevention. Prior studies have identified incomplete uptake of these guidelines in specific practice settings or patient populations. Here we characterized real-world LLT prescribing relative to guideline recommendations across seven US health systems. Methods: Cross-sectional analyses of records from the PaTH Clinical Research Network focused on three cohorts: adults with ASCVD (ASCVD cohort), those aged 40–75 without ASCVD but with diabetes mellitus (DM cohort), and those not in either prior category but with a history of low-density lipoprotein (LDL-C) >190 mg/dl (LDL-C cohort). We describe patient characteristics, patterns of care, lipid values, and documented LLT within each cohort and variation between health systems. Results: We identified 240,625 patients within the ASCVD cohort (LDL-C mean 86, SD 40 mg/dL), 113,662 patients in the DM cohort (LDL-C mean 93, SD 37 mg/dL), and 11,276 patients in the LDL-C cohort (LDL-C mean 208, SD 33 mg/dL. Among ASCVD cohort members, 37 % achieved the target LDL-C < 70 mg/dL, 62 % were prescribed LLT, 34 % were prescribed guideline-concordant high-intensity statin therapy. In the DM cohort, 27 % had LDL-C < 70 mg/dl, 54 % were on statin therapy, 19 % on high-intensity statin therapy. In the LDL-C cohort, 97 % had an LDL-C > 160 mg/dl, 44 % were on statin therapy and 16 % on high-intensity statin therapy. There was significant variability in documented LLT between health systems. Conclusions: In this real-world descriptive study across multiple health systems for patients meeting criteria for secondary or high-risk primary ASCVD prevention, most patients had no documented high-intensity statin prescriptions and did not meet LDL-C targets. There was significant variability in care across health systems. Opportunities remain for improvement in guideline adherence to reduce ASCVD risk. |
| format | Article |
| id | doaj-art-ab5955b928334875becd01b26a8d0d56 |
| institution | Kabale University |
| issn | 2666-6677 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Preventive Cardiology |
| spelling | doaj-art-ab5955b928334875becd01b26a8d0d562025-08-20T05:07:57ZengElsevierAmerican Journal of Preventive Cardiology2666-66772025-09-012310106710.1016/j.ajpc.2025.101067Real-world prescribing in accordance to ACC/AHA guidelines for lipid-lowering therapy in high-risk primary and secondary prevention of ASCVDJonathan Arnold0Deeksha Acharya1Hetal Boricha2Himal Chapagain3Aleesha Kainat4Allison Bradley5Jong-Hyeon Jeong6Kevin A. Townsend7Mohammad B. Ateya8David A. DeMicco9 YousefAlish10Michael J. Becich11Cynthia H. Chuang12Soledad A. Fernandez13Daniel E. Ford14Wenke Hwang15H. Lester Kirchner16Richard Morgan17Anuradha Paranjape18Neena A. Thomas19David A. Williams20 RozelleHegeman-Dingle21Euan McLeod22Phillip A. Saccone23Kathleen M. McTigue24Department of Medicine, University of Pittsburgh School of Medicine, USA; Corresponding author: 1321 Fifth Avenue, Suite 1, McKeesport, PA 15132, USA.UPMC McKeesport, USAUPMC McKeesport, USAUniversity of Pittsburgh Medical Center McKeesport, USAUPMC McKeesport, USADepartment of Biomedical Informatics, University of Pittsburgh School of Medicine, USAGraduate School of Public Health. University of Pittsburgh, USAPfizer Inc, USAPfizer Inc, USAPfizer Inc, USADepartment of Biomedical Informatics, Ohio State University, USADepartment of Biomedical Informatics, University of Pittsburgh School of Medicine, USAPenn State University College of Medicine, USADepartment of Biomedical Informatics, Ohio State University, USAJohns Hopkins Institute for Clinical and Translational Research, USAPenn State University College of Medicine, USADepartment of Population Health Sciences, Geisinger, USADepartment of Biomedical Informatics, University of Pittsburgh School of Medicine, USADepartment of Medicine, Lewis Katz School of Medicine, Temple University, USAMDBA Department of Biomedical Informatics, The Ohio State University, Wexner Medical Center, USADepartment of Anesthesiology, University of Michigan, USAPfizer Inc, USAPfizer Inc, USAPfizer Inc, USADepartment of Medicine, University of Pittsburgh School of Medicine, USAObjective: The value of lipid lowering therapy (LLT) for prevention of atherosclerotic cardiovascular disease (ASCVD) is well understood. American College of Cardiology and American Heart Association guidelines recommend statin therapy for secondary and high-risk primary ASCVD prevention. Prior studies have identified incomplete uptake of these guidelines in specific practice settings or patient populations. Here we characterized real-world LLT prescribing relative to guideline recommendations across seven US health systems. Methods: Cross-sectional analyses of records from the PaTH Clinical Research Network focused on three cohorts: adults with ASCVD (ASCVD cohort), those aged 40–75 without ASCVD but with diabetes mellitus (DM cohort), and those not in either prior category but with a history of low-density lipoprotein (LDL-C) >190 mg/dl (LDL-C cohort). We describe patient characteristics, patterns of care, lipid values, and documented LLT within each cohort and variation between health systems. Results: We identified 240,625 patients within the ASCVD cohort (LDL-C mean 86, SD 40 mg/dL), 113,662 patients in the DM cohort (LDL-C mean 93, SD 37 mg/dL), and 11,276 patients in the LDL-C cohort (LDL-C mean 208, SD 33 mg/dL. Among ASCVD cohort members, 37 % achieved the target LDL-C < 70 mg/dL, 62 % were prescribed LLT, 34 % were prescribed guideline-concordant high-intensity statin therapy. In the DM cohort, 27 % had LDL-C < 70 mg/dl, 54 % were on statin therapy, 19 % on high-intensity statin therapy. In the LDL-C cohort, 97 % had an LDL-C > 160 mg/dl, 44 % were on statin therapy and 16 % on high-intensity statin therapy. There was significant variability in documented LLT between health systems. Conclusions: In this real-world descriptive study across multiple health systems for patients meeting criteria for secondary or high-risk primary ASCVD prevention, most patients had no documented high-intensity statin prescriptions and did not meet LDL-C targets. There was significant variability in care across health systems. Opportunities remain for improvement in guideline adherence to reduce ASCVD risk.http://www.sciencedirect.com/science/article/pii/S2666667725001424Real-world evidenceLipid lowering therapyCardiovascular diseasesPrimary preventionSecondary preventionStatins |
| spellingShingle | Jonathan Arnold Deeksha Acharya Hetal Boricha Himal Chapagain Aleesha Kainat Allison Bradley Jong-Hyeon Jeong Kevin A. Townsend Mohammad B. Ateya David A. DeMicco YousefAlish Michael J. Becich Cynthia H. Chuang Soledad A. Fernandez Daniel E. Ford Wenke Hwang H. Lester Kirchner Richard Morgan Anuradha Paranjape Neena A. Thomas David A. Williams RozelleHegeman-Dingle Euan McLeod Phillip A. Saccone Kathleen M. McTigue Real-world prescribing in accordance to ACC/AHA guidelines for lipid-lowering therapy in high-risk primary and secondary prevention of ASCVD American Journal of Preventive Cardiology Real-world evidence Lipid lowering therapy Cardiovascular diseases Primary prevention Secondary prevention Statins |
| title | Real-world prescribing in accordance to ACC/AHA guidelines for lipid-lowering therapy in high-risk primary and secondary prevention of ASCVD |
| title_full | Real-world prescribing in accordance to ACC/AHA guidelines for lipid-lowering therapy in high-risk primary and secondary prevention of ASCVD |
| title_fullStr | Real-world prescribing in accordance to ACC/AHA guidelines for lipid-lowering therapy in high-risk primary and secondary prevention of ASCVD |
| title_full_unstemmed | Real-world prescribing in accordance to ACC/AHA guidelines for lipid-lowering therapy in high-risk primary and secondary prevention of ASCVD |
| title_short | Real-world prescribing in accordance to ACC/AHA guidelines for lipid-lowering therapy in high-risk primary and secondary prevention of ASCVD |
| title_sort | real world prescribing in accordance to acc aha guidelines for lipid lowering therapy in high risk primary and secondary prevention of ascvd |
| topic | Real-world evidence Lipid lowering therapy Cardiovascular diseases Primary prevention Secondary prevention Statins |
| url | http://www.sciencedirect.com/science/article/pii/S2666667725001424 |
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