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National trends in statin use by coronary heart disease risk category.

Ma J, Sehgal NL, Ayanian JZ, Stafford RS - PLoS Med. (2005)

Bottom Line: Lower statin use was independently associated with younger patient age, female gender, African American race (versus non-Hispanic white), and non-cardiologist care.Despite notable improvements in the past decade, clinical practice fails to institute recommended statin therapy during many ambulatory visits of patients at moderate-to-high cardiovascular risk.Innovative approaches are needed to promote appropriate, more aggressive statin use for eligible patients.

View Article: PubMed Central - PubMed

Affiliation: Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA.

ABSTRACT

Background: Only limited research tracks United States trends in the use of statins recorded during outpatient visits, particularly use by patients at moderate to high cardiovascular risk.

Methods and findings: Data collected between 1992 and 2002 in two federally administered surveys provided national estimates of statin use among ambulatory patients, stratified by coronary heart disease risk based on risk factor counting and clinical diagnoses. Statin use grew from 47% of all lipid-lowering medications in 1992 to 87% in 2002, with atorvastatin being the leading medication in 2002. Statin use by patients with hyperlipidemia, as recorded by the number of patient visits, increased significantly from 9% of patient visits in 1992 to 49% in 2000 but then declined to 36% in 2002. Absolute increases in the rate of statin use were greatest for high-risk patients, from 4% of patient visits in 1992 to 19% in 2002. Use among moderate-risk patients increased from 2% of patient visits in 1992 to 14% in 1999 but showed no continued growth subsequently. In 2002, 1 y after the release of the Adult Treatment Panel III recommendations, treatment gaps in statin use were detected for more than 50% of outpatient visits by moderate- and high-risk patients with reported hyperlipidemia. Lower statin use was independently associated with younger patient age, female gender, African American race (versus non-Hispanic white), and non-cardiologist care.

Conclusion: Despite notable improvements in the past decade, clinical practice fails to institute recommended statin therapy during many ambulatory visits of patients at moderate-to-high cardiovascular risk. Innovative approaches are needed to promote appropriate, more aggressive statin use for eligible patients.

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Related in: MedlinePlus

Use of Statins and All Lipid-Lowering Medications among United States Ambulatory Visits by Patients Diagnosed with HyperlipidemiaData from NAMCS and NHAMCS, 1992–2002.
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pmed-0020123-g001: Use of Statins and All Lipid-Lowering Medications among United States Ambulatory Visits by Patients Diagnosed with HyperlipidemiaData from NAMCS and NHAMCS, 1992–2002.

Mentions: Throughout the study period, statins were primarily used among patients whose visit involved reported hyperlipidemia, representing 97% of all statin use in 1992 and 91% in 2002. Statin use increased nearly 5-fold from 9% (99% confidence interval: 7%–12%) of all visits with reported hyperlipidemia in 1992 to 49% (42%–55%) in 2000, but then declined to 36% (31%–42%) in 2002 (Figure 1). Of note, however, the annual rate of increase in frequency of patient visits with reported hyperlipidemia was 34% in 2001 and 21% in 2002, while it averaged only 12% through 2000. The dominance of statins as lipid-lowering agents grew markedly from 47% of all lipid-lowering medications in 1992 to 87% in 2002 (Figure 1). Among available statins, lovastatin remained the therapeutic choice through 1996, after which it was surpassed by other statins, particularly simvastatin and then atorvastatin (Figure 2). Atorvastatin constituted 51% (46%–56%) and simvastatin 32% (27%–36%) of all statin use in 2002.


National trends in statin use by coronary heart disease risk category.

Ma J, Sehgal NL, Ayanian JZ, Stafford RS - PLoS Med. (2005)

Use of Statins and All Lipid-Lowering Medications among United States Ambulatory Visits by Patients Diagnosed with HyperlipidemiaData from NAMCS and NHAMCS, 1992–2002.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC1140942&req=5

pmed-0020123-g001: Use of Statins and All Lipid-Lowering Medications among United States Ambulatory Visits by Patients Diagnosed with HyperlipidemiaData from NAMCS and NHAMCS, 1992–2002.
Mentions: Throughout the study period, statins were primarily used among patients whose visit involved reported hyperlipidemia, representing 97% of all statin use in 1992 and 91% in 2002. Statin use increased nearly 5-fold from 9% (99% confidence interval: 7%–12%) of all visits with reported hyperlipidemia in 1992 to 49% (42%–55%) in 2000, but then declined to 36% (31%–42%) in 2002 (Figure 1). Of note, however, the annual rate of increase in frequency of patient visits with reported hyperlipidemia was 34% in 2001 and 21% in 2002, while it averaged only 12% through 2000. The dominance of statins as lipid-lowering agents grew markedly from 47% of all lipid-lowering medications in 1992 to 87% in 2002 (Figure 1). Among available statins, lovastatin remained the therapeutic choice through 1996, after which it was surpassed by other statins, particularly simvastatin and then atorvastatin (Figure 2). Atorvastatin constituted 51% (46%–56%) and simvastatin 32% (27%–36%) of all statin use in 2002.

Bottom Line: Lower statin use was independently associated with younger patient age, female gender, African American race (versus non-Hispanic white), and non-cardiologist care.Despite notable improvements in the past decade, clinical practice fails to institute recommended statin therapy during many ambulatory visits of patients at moderate-to-high cardiovascular risk.Innovative approaches are needed to promote appropriate, more aggressive statin use for eligible patients.

View Article: PubMed Central - PubMed

Affiliation: Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA.

ABSTRACT

Background: Only limited research tracks United States trends in the use of statins recorded during outpatient visits, particularly use by patients at moderate to high cardiovascular risk.

Methods and findings: Data collected between 1992 and 2002 in two federally administered surveys provided national estimates of statin use among ambulatory patients, stratified by coronary heart disease risk based on risk factor counting and clinical diagnoses. Statin use grew from 47% of all lipid-lowering medications in 1992 to 87% in 2002, with atorvastatin being the leading medication in 2002. Statin use by patients with hyperlipidemia, as recorded by the number of patient visits, increased significantly from 9% of patient visits in 1992 to 49% in 2000 but then declined to 36% in 2002. Absolute increases in the rate of statin use were greatest for high-risk patients, from 4% of patient visits in 1992 to 19% in 2002. Use among moderate-risk patients increased from 2% of patient visits in 1992 to 14% in 1999 but showed no continued growth subsequently. In 2002, 1 y after the release of the Adult Treatment Panel III recommendations, treatment gaps in statin use were detected for more than 50% of outpatient visits by moderate- and high-risk patients with reported hyperlipidemia. Lower statin use was independently associated with younger patient age, female gender, African American race (versus non-Hispanic white), and non-cardiologist care.

Conclusion: Despite notable improvements in the past decade, clinical practice fails to institute recommended statin therapy during many ambulatory visits of patients at moderate-to-high cardiovascular risk. Innovative approaches are needed to promote appropriate, more aggressive statin use for eligible patients.

Show MeSH
Related in: MedlinePlus