Introduction
Almost one third of U.S. adults have elevated low-density lipoprotein cholesterol,
increasing their risk of atherosclerotic cardiovascular disease. The 2018 American
College of Cardiology/American Heart Association Multisociety Cholesterol Management
Guideline recommends maximally tolerated statin for those at increased atherosclerotic
cardiovascular disease risk and add-on therapies (ezetimibe and PCSK9 inhibitors)
in those at very high risk and low-density lipoprotein cholesterol ≥70 mg/dL. Prescription
fill trends are unknown.
Methods
Using national outpatient retail prescription data from the first quarter of 2017
to the first quarter of 2022, authors determined counts of patients who filled low-,
moderate-, or high-intensity statins alone and with add-on therapies. The overall
percentage change and joinpoint regression were used to assess trends. Analyses were
conducted in March 2022–May 2022.
Results
During the first quarter of 2017 to the first quarter of 2022, patients filling a
statin increased by 25.0%, with the greatest increase in high-intensity statins (64.1%,
range=6.6–10.9 million). Low-intensity statins decreased by 29.2% (range=3.3–2.4 million).
Concurrent fills of high-intensity statin and ezetimibe rose by 210% to 579,012 patients
by the first quarter of 2022, with an increase in slope by the first quarter of 2019
for all statin intensities (p<0.01). Concurrent fills of a statin and PCSK9 inhibitor increased to 2,629, 16,169,
and 28,651 by the first quarter of 2022 for low-, moderate-, and high-intensity statins,
respectively. For patients on all statin intensities and PCSK9 inhibitor, there were
statistically significant increases in slope in the second quarter of 2019 and decreases
in the first quarter of 2020.
Conclusions
Patients filling moderate- and high-intensity statins and add-on ezetimibe and PCSK9
inhibitors have increased, indicating uptake of guideline-concordant lipid-lowering
therapies. Improvements in the initiation and continuity of these therapies are important
for atherosclerotic cardiovascular disease prevention.
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Article info
Publication history
Published online: December 01, 2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.
