Inappropriate statin therapy according to ASCVD risk: Can we do better?

Background: Statin therapy targeted at reducing 10-year risk of ASCVD has become a cornerstone of preventative health in the outpatient setting. Appropriate statin prescription can lead to improved morbidity and mortality as outlined by current American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Methods: In this empiric observational study performed in August 2018, we calculated the 10-year ASCVD risk for patients visiting the Henry Ford Hospital Academic Internal Medicine Clinic between January and December 2017, and compared the ACC/AHA guideline recommended statin intensity with the one currently prescribed. Our aim was to assess appropriateness of statin therapy based on ASCVD risk calculation and ACC/AHA guidelines. Results: Of the 2994 patients assessed, approximately 1548 patients were prescribed an inappropriate intensity of statin based on 10-year ASCVD risk calculation (p \u3c 0.001). For female patients, the odds of appropriate statin dose prescription increased by approximately 81.9% (odds ratio 1-1.819) when compared to male patients (95% CI 1.559-2.124). For black patients, the odds of appropriate statin prescription decreased by 32.2% (odds ratio 1-0.678) when compared to white patients (95% CI 0.532-0.864). Approximately 1245 patients currently taking high-intensity statin did not qualify for one as compared to 484 patients (p \u3c 0.001). Conclusion: Calculation of 10-year ASCVD risk is an integral part of guiding statin prescription and preventative health therapy in the outpatient setting, However, an increasing percentage of patients are not managed adequately according to ACC/AHA guidelines. Race, gender, and income disparities appear to be major factors influencing appropriateness of statin prescription. This demonstrates a major opportunity for potential intervention to improve statin prescription and patient health outcomes.https://scholarlycommons.henryford.com/merf2019hcd/1000/thumbnail.jp