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Lipid management in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry
Journal article   Peer reviewed

Lipid management in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry

Ann Marie Navar, Tracy Y Wang, Shuang Li, Jennifer G Robinson, Anne C Goldberg, Salim Virani, Veronique L Roger, Peter W F Wilson, Joseph Elassal, Eric D Peterson, …
The American heart journal, Vol.193, pp.84-92
11/2017
DOI: 10.1016/j.ahj.2017.08.005
PMCID: PMC5714300
PMID: 29129260
url
https://www.ncbi.nlm.nih.gov/pmc/articles/5714300View
Open Access

Abstract

The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDL-C) targets toward statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk. Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary prevention patients from 138 PALM Registry practices. Overall, 74.7% of eligible adults were on statins; only 42.4% were on guideline-recommended intensity. Relative to primary prevention patients, ASCVD patients were more likely to be on a statin (83.6% vs 63.4%, P<.0001) and guideline-recommended intensity (47.3% vs 36.0%, P<.0001). Men were more likely than women to be prescribed recommended intensity for primary (odds ratio [OR] 1.87, 95% CI 1.49-2.34) and secondary (OR 1.47, 95% CI 1.26-1.70) prevention. In primary prevention, increasing age, diabetes, obesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients (OR 1.71, 95% CI 1.41-2.09), as were those seen by cardiologists (OR 1.43, 95% CI 1.12-1.83). Median LDL-C levels were highest among patients not on statins (124.0 mg/dL) and slightly higher among those on lower-than-recommended intensity compared with recommended-therapy recipients (88.0 and 84.0 mg/dL, respectively; P≤.0001). In routine contemporary practice, 1 in 4 guideline-eligible patients was not on a statin; less than half were on the recommended statin intensity. Untreated and undertreated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment.
 Registries Primary Health Care - methods Follow-Up Studies Humans Risk Factors Male Treatment Outcome Secondary Prevention - methods Atherosclerosis - blood Time Factors Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Lipids - blood Primary Prevention - methods Female Aged Disease Management Retrospective Studies Atherosclerosis - prevention & control

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