LDL-C test after ASCVD event improves statin adherence, intensification

Low-density lipoprotein cholesterol (LDL-C) testing appears to improve statin adherence and management in patients with a history of atherosclerotic cardiovascular disease (ASCVD), suggests a recent study.

This longitudinal study enrolled adult members of Kaiser Permanente Northern California hospitalized with an ASCVD event (myocardial infarction or stroke) during 1 January 2016 to 31 December 2017, with follow-up through 31 December 2019.

Statin adherence (estimated using continuous medication gap [CMG]) and intensification (defined by an increased dose or switch to a higher-intensity statin) based on pharmacy dispensing were the primary outcomes. The exposure of interest was the first outpatient LDL-C test following an ASCVD event. Baseline for follow-up was LDL-C test date or a date assigned using incidence density sampling.

The authors specified multivariate logistic regression models to estimate the odds ratios (ORs) for statin adherence or intensification among those with vs without an LDL-C test, with adjustment for age, sex, race/ethnicity, smoking, hypertension, diabetes, body mass index, and estimated glomerular filtration rate.

A total of 19,604 adults hospitalized with ASCVD (mean age 69.5 years, 33.0 percent female) were included, of whom 7,064 were not on high-intensity statins.

Participants who had an LDL-C test had a significantly higher prevalence of good adherence (continuous medication gap ≤20 percent) than those who did not (80.2 percent vs 75.9 percent; OR, 1.38, 95 percent confidence interval [CI], 1.28‒1.49; p<0.001).

In addition, LDL-C testing correlated with markedly higher rates of treatment intensification (16.1 percent vs 10.7 percent; OR, 1.51, 95 percent CI, 1.29‒1.76; p<0.001).

“LDL-C testing is recommended for patients with a history of ASCVD and may be a high-value and low-cost intervention to improve adherence and statin management,” the authors said.