The 2018 American Heart Association (AHA)/ American College of Cardiology (ACC) cholesterol guideline indicated a greater need for lipid monitoring than the previous 2013 guideline. However, results from a recent study indicate that lipid monitoring did increase following the guideline update, but as a whole, rates remained low, according to the Journal of Clinical Lipidology.
To determine the proportion of patients who were screened according to the updated guidance, researchers examined the effect the updated guideline had on the amount of patients who completed a lipid panel within 3 months of statin initiation.
The study authors identified 13,726 primary care patients in the University of Colorado health system aged 18 to 89 years and divided them into 2 cohorts: patients who were prescribed a statin between January 1, 2018 and June 30, 2018, the time period before the guideline update (n=7476), and patients who were prescribed a statin between January 1, 2019 and June 30, 2019, after guideline update was published (n=6250). Patients with active liver disease, as well as pregnant women, were excluded.
Patients were generally older (>60 years) and White. The average low-density lipoprotein cholesterol (LDL-C) for the pre-2018 guideline cohort and the post-2018 guideline cohort were 112.2 mg/dL and 116.4 mg/dL, respectively.
The number of patients who completed a lipid panel within 3 months of statin initiation was significantly higher in the postguideline group compared with the preguideline group (16.2% vs 13.9%, adjusted P < .001) and within 6 months (33.7% of patients in the post-guideline group vs 29.9% in the pre-guideline group [adjusted P <.001]).
The mean percentage of LDL-C reduction for the preguideline cohort was 20.3% compared with 25.3% in the postguideline cohort. Of the 1545 patients in the post-guideline cohort who completed both baseline and follow-up panels, 56% warranted a change in therapy based on LDL-C reduction goals listed in the 2018 guideline; however, only 5% of these patients had their lipid-lowering therapy changed. Out of all patients who experienced a change in therapy, 82% had their statin dose increased, and 18% were prescribed an additional nonstatin LDL-C lowering medicine.
Patients using statins for primary prevention were less likely to require a change in lipid-lowering therapy than atherosclerotic cardiovascular disease (ASCVD) patients (44% vs 83%). However, when a change in therapy was indicated according to the 2018 guidelines, 12% of primary hypercholesterolemia patients had their therapy changed compared with 3% of ASCVD patients. Researchers called this disparity “alarming,” and stated that the highest-risk population having the lowest proportion of patients with a therapy change is indicative of a deficiency in recognizing opportunities for clinical intervention.
The study authors noted that although there was a statistically significant increase in lipid monitoring following the 2018 guideline updates, only 1 in 6 patients were monitored per guideline stipulations, and few patients received recommended changes to their lipid-lowering therapy.
“This lack of follow-up monitoring and evaluation is a major barrier to practicing evidence-based medicine and effectively prohibits achievement of optimal cardiovascular risk reduction within patient care,” the study authors concluded.
Tunoa JA, Billups SJ, Lowe RN, Saseen JJ. Early impact of the 2018 AHA/ACC/multisociety cholesterol guideline on lipid monitoring after statin initiation. J Clin Lipidol. 2020;S1933-2874(20)30263-4.