Statins are a commonly recommended lipid-lowering therapy for the prevention of atherosclerotic cardiovascular disease (ASCVD), particularly for patients with severe hyperlipidemia, also known as high cholesterol, defined as an LDL cholesterol test of 190 mg/dL or greater.1 Guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) recommend high-intensity statins for all adults with an LDL level of 190 mg/dL or higher to reduce the risk of cardiovascular events.1 Despite these clear recommendations, use of statin therapy remains much lower than recommended, with prior studies showing that less than 50% of eligible patients receive appropriate lipid-lowering treatment.2
To understand how clinical practice compared to the guidelines for lipid-lowering medication prescribing in recent years, we studied 763,498 patients with an LDL test result of 190 mg/dL or higher between January 1, 2019, and February 12, 2023, and an outpatient visit at least two years later. We grouped patients by the type of lipid-lowering medication they had documented before or within two years following their LDL test.
We found that 25.1% of patients did not have any lipid-lowering medications documented, as seen in Figure 1. Lipid-lowering medication documentation was particularly low among younger adults, with 46.2% of those aged 18 to 39 not having one documented, compared to 22.8% in those aged 40 to 74 and 18.0% in those aged 75+. Statins were the most common type of lipid-lowering medication documented.
Next, we evaluated lipid-lowering medication rates in patients who were at increased risk for cardiovascular events. We found that those with a history of MI, stroke, or type 2 diabetes had the lowest rates of no lipid-lowering medications at 3.4%, 7.1%, and 9.2%, respectively. Patients with familial hyperlipidemia had lipid-lowering medications documented more often than the overall population, at 13.8% with no documented lipid-lowering medication.
