Lipid-lowering therapy use and intensification among United States veterans following myocardial infarction or coronary revascularization between 2015 and 2019

Alexander R. Zheutlin, The University of Utah School of Medicine, United States of America
Catherine G. Derington, The University of Utah School of Medicine, United States of America
Jennifer S. Herrick, The University of Utah School of Medicine, United States of America
Robert S. Rosenson, Icahn School of Medicine at Mount Sinai, New York
Bharat Poudel, UAB School of Public Health, United States of America
Monika M. Safford, Weill Cornell Medicine, New York
Todd M. Brown, University of Alabama, United States of America
Elizabeth A. Jackson, University of Alabama, United States of America
Mark Woodward, The George Institute for Global Health, United Kingdom
Salim S. Virani, Baylor College of Medicine, Texas

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Background: Understanding how statins, ezetimibe, and PCSK9i (proprotein convertase subtilisin/kexin type 9 serine protease inhibitors) are prescribed after a myocardial infarction (MI) or elective coronary revascularization may improve lipid-lowering therapy (LLT) intensification and reduce recurrent atherosclerotic cardiovascular disease events. We described the use and intensification of LLT among US veterans who had a MI or elective coronary revascularization between July 24, 2015, and December 9, 2019, within 12 months of hospital discharge.
Methods: LLT intensification was defined as increasing statin dose, or initiating a statin, ezetimibe, or a PCSK9i, overall and among those with an LDL-C (low-density lipoprotein cholesterol) 70 or 100 mg/dL. Poisson regression was used to determine patient characteristics associated with a greater likelihood of LLT intensification following hospitalization for MI or elective coronary revascularization.
Results: Among 81 372 index events (mean age, 69.0 years, 2.3% female, mean LDL-C 89.6 mg/dL, 33.8% with LDL-C <70 mg>/dL), 39.7% were not taking any LLT, and 22.0%, 37.2%, and 0.6% were taking a low-moderate intensity statin, a high-intensity statin, and ezetimibe, respectively, before MI/coronary revascularization during the study period. Within 14 days, 3 months, and 12 months posthospitalization, 33.3%, 41.9%, and 47.3%, respectively, of veterans received LLT intensification. LLT intensification was most common among veterans taking no LLT (82.5%, n=26 637) before MI/coronary revascularization. Higher baseline LDL-C, having a lipid test, and attending a cardiology visit were each associated with a greater likelihood of LLT intensification, while age 75 versus <65 years was associated with a lower likelihood of LLT intensification within 12 months>posthospitalization.
Conclusions: Less than half of veterans received LLT intensification in the year after MI or coronary revascularization suggesting a missed opportunity to reduce atherosclerotic cardiovascular disease risk.