† Cholesterol treatment trends from 2014 - 2023 in 3 Million US individuals with ASCVD: a retrospective cohort analysis using the Family Heart DatabaseTM

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.015

Diane MacDougall MS, Hilly Paige BS, Seth Baum MD, Katherine Wilemon BS, Keith Ferdinand MD

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引用次数: 0

Abstract

Background/Synopsis

Over the last decade, the preponderance of clinical trial data and the availability of innovative therapies have supported attainment of lower LDL-C levels, while the 2018 US guideline and quality measures have primarily emphasized use of statins. How these and other factors have impacted cholesterol treatment over time is unknown.

Objective/Purpose

This real-world data analysis aims to characterize annual use of LDL-C lowering therapies and attainment of LDL-C goals in US individuals with atherosclerotic cardiovascular disease (ASCVD).

Methods

A retrospective cohort analysis using medical claims and lab data from the Family Heart DatabaseTM that was created by the Family Heart Foundation. Individuals with an ASCVD diagnosis prior to 2014 and ≥ 1 medication claim every year from 2014 to 2023 were included. Cholesterol lowering therapies included statins, proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9is), ezetimibe and bempedoic acid. Percentages were adjusted for age and sex using logistic regression.

Results

Individuals (n=3,042,530) with mean (SD) age 63.7 (9.2) years were 45% female. From 2014 to 2023, annual use of low/moderate intensity statins consistently decreased from 34% to 27%, while corresponding use of high intensity statins increased from 17% to 29%. Use of cholesterol lowering therapies and attainment of LDL-C goals increased over time; however, in 2023 just 55% of individuals were receiving LDL-C lowering therapy and only 34% had attained an LDL-C level <70 mg/dL (see table).

Conclusions

In the largest analysis of cholesterol treatment trends in US individuals with ASCVD to date, use of LDL-C lowering therapies and attainment of LDL-C goals gradually improved from 2014 to 2023. However, by 2023, 66% of these individuals failed to attain an LDL-C level < 70 mg/dL and 45% received no LDL-C lowering therapy. These findings highlight suboptimal cholesterol treatment and slow improvement over time despite increasing availability of multiple cost-effective and safe therapies.

Previously Published: Yes, Accepted for oral presentation at EAS May 2025 in Glasgow

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†2014 - 2023年300万美国ASCVD患者的胆固醇治疗趋势：使用家族心脏数据库的回顾性队列分析

在过去的十年中，临床试验数据的优势和创新疗法的可用性支持了低LDL-C水平的实现，而2018年美国指南和质量措施主要强调了他汀类药物的使用。随着时间的推移，这些因素和其他因素是如何影响胆固醇治疗的尚不清楚。目的/目的本真实世界数据分析旨在描述美国动脉粥样硬化性心血管疾病（ASCVD）患者每年使用降LDL-C治疗和达到LDL-C目标的情况。方法采用来自家庭心脏基金会创建的家庭心脏数据库（Family Heart database）的医疗声明和实验室数据进行回顾性队列分析。纳入2014年之前诊断为ASCVD且2014年至2023年每年有≥1个药物声明的个体。降胆固醇治疗包括他汀类药物、蛋白转化酶枯草杆菌素/克辛蛋白9型抑制剂（PCSK9is）、依折替米贝和苯甲多酸。使用逻辑回归对年龄和性别的百分比进行调整。结果患者（n=3,042,530）例，平均（SD）年龄63.7（9.2）岁，女性占45%。从2014年到2023年，低/中强度他汀类药物的年使用率从34%持续下降到27%，而相应的高强度他汀类药物的年使用率从17%上升到29%。随着时间的推移，使用降胆固醇疗法和达到LDL-C目标的人数增加；然而，在2023年，只有55%的人接受了降低LDL-C的治疗，只有34%的人达到了70 mg/dL的LDL-C水平（见表）。结论：在迄今为止对美国ASCVD患者胆固醇治疗趋势的最大规模分析中，从2014年到2023年，LDL-C降低治疗的使用和LDL-C目标的实现逐渐改善。然而，到2023年，这些人中有66%未能达到LDL-C水平。70 mg/dL和45%未接受降LDL-C治疗。这些发现强调了胆固醇治疗的次优性和缓慢的改善，尽管越来越多的具有成本效益和安全的治疗方法可用。以前发表：是的，接受口头报告在EAS 2025年5月在格拉斯哥

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.