Hyperlipidemia

Background

Hypercholesterolemia is a major, modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD) events. Statins are evidence-based first line therapy for primary and secondary and prevention of ASCVD. The 2013 Cholesterol Guideline would treat approximately 12.8 million more adults for hypercholesterolemia and 673,684 ASCVD events would be prevented with implementing the 2013 Guidelines. Given the demonstrated effectiveness of statin therapy, this observation suggests that applying this small change in patient care could prevent a substantial number of expected ASCVD events.

Study Performed by CCI

This study used electronic health record system data of patients seen at approximately 350 clinical sites in Care Coordination Institute Quality Improvement Network. The primary analysis included adults aged 18-80 years with a minimum of one valid blood pressure (BP), lipid profile, and medication for any disease state as well as cigarette smoking, cardiovascular disease and diabetes status, between January 1, 2011, and June 30, 2014.

The reduction in ASCVD events was also calculated using the 10-yr ASCVD risk calculator included in the newer guideline. The number of statin-eligible adults not currently on statin that would require treatment to prevent a major ASCVD event over 10 years was estimated, and the results were extrapolated to the South Carolina adult population.

Table X Summary Results Extrapolated to US and SC 18-80 population
StudyUS PopulationSC Population
Additional treated base on 2013 Guidelines5779712.8M *191758**
Patients needed to treat to prevent ASCVD Event191919
10 years ASCVD Events Prevented304267368410093
Relative Risk Reduction29.3%29.3%29.3%
Absolute Risk Reduction5.3%5.3%5.3%

*Pencina, 2014, NJEM

**SC percent of US population 2010 Census

Conclusion: The findings from our study of a clinically-based adult population suggest that effective implementation of the 2013 Cholesterol Guideline among adults currently not on a statin but statin eligible has the potential to prevent a significant number of ASCVD events. In these adults, recommended intensity statin therapy was predicted to reduce relative risk for ASCVD events 29.5% and absolute risk 5.3% over 10 years with a number needed-to-treat of 19.



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