Variation in Lipid-Lowering Therapy Use in Patients With Low-Density Lipoprotein Cholesterol ≥190 mg/dL: Insights From the National Cardiovascular Data Registry-Practice Innovation and Clinical Excellence Registry

Circulation. Cardiovascular Quality and Outcomes
Salim S ViraniChristie M Ballantyne

Abstract

Patients with low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL are at high risk of atherosclerotic cardiovascular disease events. Treatment guidelines recommend intensive treatment in these patients. Variation in the use of lipid-lowering therapies (LLTs) in these patients in a national sample of cardiology practices is not known. Using data from the American College of Cardiology National Cardiovascular Data Registry-Practice Innovation and Clinical Excellence registry, we assessed the proportion of patients with LDL-C ≥190 mg/dL (n=49 447) receiving statin, high-intensity statin, LLT associated with ≥50% LDL-C lowering, ezetimibe, or a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor between January 2013 and December 2016. We assessed practice-level rates and variation in LLT use using median rate ratio (MRR) adjusted for patient and practice characteristics. MRRs represent the likelihood that 2 random practices would differ in treatment of identical patients with LDL-C ≥190 mg/dL. The proportion of patients receiving a statin, high-intensity statin, LLT associated with ≥50% LDL-C reduction, ezetimibe, or PCSK9 inhibitor were 58.5%, 31.9%, 34.6%, 8.5%, and 1.5%, respectively. Median practice-level rates a...Continue Reading

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Citations

Mar 30, 2019·Journal of the American Heart Association·Ulrich LaufsErik S G Stroes
Jan 11, 2020·Journal of the American College of Cardiology·Thomas M MaddoxFrederick A Masoudi
Jan 28, 2021·Circulation·Salim S ViraniUNKNOWN American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee
Apr 28, 2021·Journal of the American Heart Association·Elias J DayoubPeter W Groeneveld
Jul 31, 2021·American Journal of Preventive Cardiology·Matthew E GoldAnn Marie Navar
Sep 2, 2021·Journal of the American Heart Association·Wael E EidJoseph R Nolan
Sep 26, 2021·Current Opinion in Lipidology·Toshiyuki Nishikido, Kausik K Ray

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