Less than one-third of patients are on statin therapy 3 years following hospital admission for atherosclerotic cardiovascular disease (ASCVD), according to a recent study presented at AHA 2017.

Researchers from the Intermountain Medical Center Heart Institute, Salt Lake City, Utah, US assessed data from the discharge medication programme initiated by Intermountain Healthcare in 1999 to identify 62,070 patients aged ≥18 years (mean age 65.9 years, 64.7 percent male) who were admitted to Intermountain Healthcare with ASCVD between 1999 and 2013, survived the initial hospitalization, and were followed for ≥3 years or until death.

Most patients in the study had coronary artery disease (CAD; 69.4 percent), with a lower proportion having cerebrovascular disease (CVD; 18.6 percent) and peripheral arterial disease (PAD; 12 percent).

Seventy-one percent of patients (n=43,737) were prescribed statins upon discharge from hospital. At 1 year after discharge, 37.4 percent of patients (n=23,189) were on statins, which further reduced to 30.1 percent at 3 years post-discharge (n=18,679). [AHA 2017, session EP.AOS.636.N, presentation 318]

Of the 29 percent of patients (n=18,333) not prescribed a statin upon hospital discharge, 6.6 percent (n=1,206) later initiated statin therapy.

Patients with no incidence of major adverse cardiac events by 3 years post-hospitalization had a higher likelihood of discontinuing their statin therapy (odds ratio [OR], 4.17), as were those who did not undergo follow-up LDL-C assessment (OR, 3.13), and those who had not used statins prior to initial ASCVD incident (OR, 2.38; p<0.0001 for all).

Patients with renal failure were more likely to discontinue statins (OR, 1.21; p<0.0001) as were those with PAD or CVD (OR, 1.48 and 1.59, respectively; p<0.0001 for each vs CAD), while patients who had to shoulder the cost of statins were more prone to statin discontinuation compared with those whose cost was covered by insurance (OR, 1.83).

According to the researchers, efforts are being made to improve statin prescription for patients who need it and to encourage long-term use.

These efforts would include extending the use of the discharge programme to physician clinics which would help “track statin prescribing and compliance in a systematic way”, increasing LDL-C screenings in at-risk patients, and improving patient education particularly with regards to the benefits of statins, said lead investigator Dr J. Brent Muhlestein from the Intermountain Medical Center Heart Institute.

“We [also] need to find a better class of drugs,” he added. “Researchers are … testing a new class of drugs called PCSK9 inhibitors, which have the potential for filling [the] treatment gap because they have, as of yet, no identified side effects. Original studies show they’re very safe, but their safety has to be proven in large trials,” he said, advocating for statin continuation in the meantime.