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Research ArticleOriginal Research

Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal

Quyen Ngo-Metzger, Samuel Zuvekas, Paul Shafer, Howard Tracer, Amanda E. Borsky and Arlene S. Bierman
The Journal of the American Board of Family Medicine November 2019, 32 (6) 807-817; DOI: https://doi.org/10.3122/jabfm.2019.06.180313
Quyen Ngo-Metzger
From the Agency for Healthcare Research and Quality, Rockville, MD (SZ, PS, HT, AB, ASB); Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA (PS); Kaiser Permanente School of Medicine (QN-M).
MD, MPH
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Samuel Zuvekas
From the Agency for Healthcare Research and Quality, Rockville, MD (SZ, PS, HT, AB, ASB); Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA (PS); Kaiser Permanente School of Medicine (QN-M).
PhD
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Paul Shafer
From the Agency for Healthcare Research and Quality, Rockville, MD (SZ, PS, HT, AB, ASB); Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA (PS); Kaiser Permanente School of Medicine (QN-M).
PhD
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Howard Tracer
From the Agency for Healthcare Research and Quality, Rockville, MD (SZ, PS, HT, AB, ASB); Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA (PS); Kaiser Permanente School of Medicine (QN-M).
MD
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Amanda E. Borsky
From the Agency for Healthcare Research and Quality, Rockville, MD (SZ, PS, HT, AB, ASB); Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA (PS); Kaiser Permanente School of Medicine (QN-M).
DrPH, MPP
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Arlene S. Bierman
From the Agency for Healthcare Research and Quality, Rockville, MD (SZ, PS, HT, AB, ASB); Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA (PS); Kaiser Permanente School of Medicine (QN-M).
MD, MS
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Article Figures & Data

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    Figure 1.

    Statin use among adults with history of diagnosed Ascvd, 2008 to 2016. Source: Agency for Health Care Research and Quality, Medical Expenditure Panel Survey, Full-Year Consolidated Files, 2008 to 2016. Note: All years were age-adjusted to match the 2016 age distribution.

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    Table 1.

    Demographic and Health Characteristics of Adults Aged 40 Years and Older with History of Diagnosed ASCVD, 2014 to 2016

    CharacteristicnWeighted %95% CI
    Age.in years
        40 to 495958.7(7.6 to 9.8)
        50 to 591,24717.3(15.9 to 18.7)
        60 to 6480412.6(11.4 to 13.7)
        65 to 6987115.2(13.7 to 16.7)
        70 to 7594617.4(15.8 to 19.0)
        76 to 795139.2(8.1 to 10.2)
        80 to 845629.9(8.9 to 10.9)
        85 and above5469.8(8.6 to 11.0)
    Sex
        Women3,03946.3(44.5 to 48.1)
        Men3,04553.7(51.9 to 55.5)
    Race/ethnicity
        Hispanic1,1249.5(8.0 to 11.0)
        Non-Hispanic, white3,19873.5(71.3 to 75.7)
        Non-Hispanic, African American1,32011.1(9.7 to 12.6)
        Non-Hispanic, Asian2542.7(2.0 to 3.5)
        Non-Hispanic, Other1883.1(2.2 to 4.0)
    Marital status
        Unmarried3,15944.5(42.3 to 46.7)
        Married2,92555.5(53.3 to 57.7)
    Education
        Did not complete high school2,32231.1(29.3 to 32.8)
        High school graduate or GED1,30422.4(20.7 to 24.1)
        Some college1,40724.9(23.1 to 26.7)
        College degree or higher99121.0(19.2 to 22.9)
    Insurance coverage
        Medicare4,06469.7(67.8 to 71.6)
        Private1,12420.4(18.7 to 22.1)
        Medicaid5686.0(5.1 to 6.9)
        Uninsured3283.9(3.2 to 4.6)
    Census region
        Northeast1,00317.8(15.8 to 19.8)
        Midwest1,23122.5(20.2 to 24.9)
        South2,62840.8(38.1 to 43.5)
        West1,22218.8(17.0 to 20.7)
    MSA
        MSA5,02481.3(78.1 to 84.6)
        Non-MSA1,06018.7(15.4 to 21.9)
    History of cardiovascular disease
        CHD to MI to or angina4,55576.2(74.6 to 77.9)
        Stroke2,53839.5(37.8 to 41.2)
    ASCVD risk factors
        Doctor ever told high cholesterol4,50475.1(73.4 to 76.8)
        Doctor ever told had hypertension4,98280.9(79.4 to 82.4)
        Doctor ever told had diabetes2,12231.7(29.8 to 35.6)
        Current smoker1,02016.8(15.1 to 18.4)
    Usual source of care
        No5317.9(6.8 to 8.9)
        Yes5,55392.1(91.1 to 93.2)
    • Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey 2014 to 2016.

    • ASCVD, atherosclerotic cardiovascular disease; CHD, coronary heart disease; CI, confidence interval; ED, emergency department; GED, General Equivalency Diploma; MI, myocardial infarction; MSA, Metropolitan Statistical Area.

    • View popup
    Table 2.

    Statin Use in Adults with History of Diagnosed ASCVD by Age Group, 2014 to 2016

    Total PopulationStatin Users
    NWeighted Population, Millions (95% CI)Weighted Users, Millions (95% CI)Weighted % (95% CI)
    Age 40 years and older6,08423.4 (22.1 to 24.6)13.9 (13.0 to 14.8)59.4 (57.4 to 61.5)
    Age 40 to 75 years4,46316.6 (15.7 to 17.6)9.7 (9.0 to 10.4)58.3 (55.9 to 60.6)
    Age 76 years and older1,6216.7 (6.2 to 7.3)4.2 (3.8 to 4.7)62.3 (59.0 to 65.7)
    • ASCVD, atherosclerotic cardiovascular disease; CI, confidence interval.

    • Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2014 to 2016.

    • View popup
    Table 3.

    Odds of Current Statin Use and Sociodemographic Characteristics, Adults Aged 40 Years and Older with History of Diagnosed ASCVD, 2014 to 2016 (n = 6,039)

    CharacteristicOdds Ratio(95% CI)P-Value
    Age, in years
        40 to 49 (reference)1.00——
        50 to 591.60(1.14 to 2.26).007
        60 to 642.43(1.66 to 3.56)<.001
        65 to 693.36(2.15 to 5.22)<.001
        70 to 753.09(2.02 to 4.74)<.001
        76 to 793.43(2.14 to 5.49)<.001
        80 to 843.03(1.93 to 4.74)<.001
        85 and above2.03(1.27 to 3.24).003
    Female0.65(0.55 to 0.77)<.001
    Race/ethnicity
        Non-Hispanic, white (reference)1.00——
        Hispanic0.69(0.52 to 0.92).011
        Non-Hispanic, African American0.81(0.63 to 1.04).102
        Non-Hispanic, Asian1.25(0.82 to 1.90).297
        Non-Hispanic, other0.70(0.40 to 1.21).201
    Has a usual source of care1.87(1.37 to 2.56)<.001
    Doctor ever told high cholesterol6.22(5.02 to 7.72)<.001
    Doctor ever told had high blood pressure1.33(1.08 to 1.65).009
    Doctor ever told had diabetes1.51(1.24 to 1.85)<.001
    Current smoker0.90(0.70 to 1.14).375
    SF-12 Physical Component Score1.01(1.00 to 1.02).022
    Married1.26(1.02 to 1.57).033
    Education
        Did not complete high school (reference)1.00——
        High school graduate or GED1.23(1.00 to 1.52).055
        Some college1.39(1.08 to 1.80).011
        College degree or higher1.15(0.87 to 1.51).339
    Insurance coverage
        Private (reference)1.00——
        Medicare1.05(0.76 to 1.44).781
        Medicaid1.13(0.78 to 1.63).527
        Uninsured0.90(0.60 to 1.35).607
    Census region
        Northeast (reference)1.00——
        Midwest1.17(0.88 to 1.55).271
        South0.82(0.62 to 1.08).165
        West0.90(0.67 to 1.22).504
    MSA1.11(0.85 to 1.44).451
        Constant0.04(0.02 to 0.08)<.001
    • ASCVD, atherosclerotic cardiovascular disease; CI, confidence interval; GED, General Equivalency Diploma; MSA, metropolitan statistical area; SF-12, 12-Item Short Form Health Survey (SF-12).

    • Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2014 to 2016.

    • View popup
    Table 4.

    Prevalence Rate of Diagnosed ASCVD, 2008 to 2016

    YearPrevalence Per 100095% CI
    2008161.0151.3 to 170.6
    2009157.5148.8 to 166.3
    2010153.7145.5 to 162.0
    2011149.5140.7 to 158.3
    2012147.6138.7 to 156.6
    2013155.3146.9 to 163.7
    2014156.6147.9 to 165.3
    2015153.4144.6 to 162.2
    2016152.6144.6 to 160.6
    • ASCVD, atherosclerotic cardiovascular disease.

    • Adjusted Wald test to Prob > F = 0.1931.

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The Journal of the American Board of Family     Medicine: 32 (6)
The Journal of the American Board of Family Medicine
Vol. 32, Issue 6
November-December 2019
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Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal
Quyen Ngo-Metzger, Samuel Zuvekas, Paul Shafer, Howard Tracer, Amanda E. Borsky, Arlene S. Bierman
The Journal of the American Board of Family Medicine Nov 2019, 32 (6) 807-817; DOI: 10.3122/jabfm.2019.06.180313

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Statin Use in the U.S. for Secondary Prevention of Cardiovascular Disease Remains Suboptimal
Quyen Ngo-Metzger, Samuel Zuvekas, Paul Shafer, Howard Tracer, Amanda E. Borsky, Arlene S. Bierman
The Journal of the American Board of Family Medicine Nov 2019, 32 (6) 807-817; DOI: 10.3122/jabfm.2019.06.180313
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Keywords

  • Atherosclerosis
  • Cardiovascular Diseases
  • Chronic Disease
  • Hypercholesterolemia
  • Hyperlipidemia
  • Logistic Models
  • Preventive Medicine
  • Secondary Prevention
  • Statins
  • Surveys and Questionnaires

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