OBJECTIVES: To explore the utilization patterns of lipid-lowering therapies in patients at high risk for or with atherosclerotic cardiovascular disease (ASCVD)

METHODS: A retrospective cohort study was conducted using the Korean Health Insurance Review & Assessment (HIRA) Service database. Patients aged ≥18 years were included if they initiated statin and/or ezetimibe between January 1, 2012 and December 31, 2014 without previous claims for statin and/or ezetimibe within 12 months before index date. Index date was defined as the date of first prescription for statin and/or ezetimibe. Patients were classified into following groups: patients with ASCVD (defined as myocardial infarction, angina, coronary revascularization, peripheral artery disease, ischemic stroke, and transient ischemic attack) and patients with hypertension or diabetes without a history of ASCVD. Patients were followed for 1 year after the index date to assess treatment patterns like discontinuation, switching, reinitiation, and augmentation. Medication adherence was measured as medication possession ratio (MPR). Possible statin intolerance was assessed based on a previously developed algorithm of treatment modifications.

RESULTS: Among 2,600,810 patients who initiated statin and/or ezetimibe, 746,421 (28.7%) were with ASCVD, 956,356 (36.8%) were with hypertension, and 605,198 (23.3%) were with diabetes. The average MPR was 69.0% for statin and 61.0% for ezetimibe. During the follow-up period, 50.9% of patients with ASCVD, 51.6% of patients with hypertension, and 53.4% of patients with diabetes had ≥1 treatment modification including permanent discontinuation (19.4%, 21.6%, and 21.1%, respectively), reinitiation (6.1%, 6.7%, and 7.6%, respectively), switching (12.4%, 11.5%, and 12.3%, respectively), and augmentation (1.4%, 1.4%, and 1.7%, respectively). Possible statin intolerance was observed in 21.6% of patients with ASCVD, 21.1% of patients with hypertension, and 22.1% of patients with diabetes.

CONCLUSIONS: High treatment modification rate in lipid-lowering therapies and increased possible statin intolerance highlights an unmet need in the prevention and management of ASCVD.