Patterns of statin use and cholesterol goal attainment in a high-risk cardiovascular population: A retrospective study of primary care electronic medical records

- Three statin patterns were defined, based on statin type, potency, and 1-year change.
- Patterns of statin use were defined as low, moderate, and high intensity.
- Prescription of patterns was not related to baselineLDL-cholesterol levels.
- Management in primary care should be focused on improving adherence to treatment.
- Initial pattern prescribed and LDL-cholesterol or CV risk needs bettter alignment.

ObjectiveTo describe real-life patterns of statin use and cholesterol goal attainment in a retrospective cohort of patients with high cardiovascular risk.MethodsRetrospective cohort study of 21,636 individuals, 18.34% women, mean age 63.30 years (standard deviation 6.29). New statin users aged 35 to 74 years at high cardiovascular risk and with no previous cardiovascular disease in primary care electronic medical records (2006-2011). Patterns of statin use were based on statin type, potency, and 1-year statin switches.OutcomesRelative mean reductions over 1 year and probability of goal attainment (<3.3 mmol/L). Natural patterns of statin use were identified using multiple correspondence analysis; general linear and logistic models were used to estimate low-density lipoprotein cholesterol (LDL-C) reductions and goal attainment probability.ResultsThree patterns of statin use were defined: low (3.82% of the population), moderate (71.94%), and high intensity (24.24%). After 1 year, potency decreased 42.74%, 64.16%, and 50.94%, respectively, and 37.41%, 29.47%, and 30.16% of the population stopped taking statins in low, moderate, and high patterns, respectively. Relative reductions in LDL-C: low intensity, 15.7% (95% confidence interval [CI]: −22.96 to 54.36); moderate intensity, 29.72% (95% CI: 29.12-30.32); and high intensity, 24.20% (95% CI: −8.08 to 40.32). There was a direct relationship between higher intensity patterns and greater probability of goal attainment.ConclusionsThree real-life patterns of statin use were identified. Lipid management strategies in primary care should focus on improving adherence to treatment. People starting at low potency should switch to a moderate pattern; more intensive therapies should be considered in who require a larger LDL-C reduction to reach therapeutic targets, patients with good treatment adherence who do not achieve the goal with a moderate pattern of therapy or patients at very high risk.