TY - JOUR
T1 - Underuse of statins for secondary prevention of atherosclerotic cardiovascular disease events among ambulatory surgical patients
AU - Schonberger, Robert B.
AU - Vallurupalli, Vivek
AU - Matlin, Hollie
AU - Blitz, Daina
AU - Nwozuzu, Adambeke
AU - Barron, Brian
AU - Zhang, Yuemei
AU - Dai, Feng
AU - Jacoby, Daniel
AU - Nasir, Khurram
AU - Bardia, Amit
N1 - Funding Information:
This work was supported in part by CTSA Grant UL1 RR024139 from the National Center for Advancing Translational Sciences (NCATS) . The content is solely the responsibility of the authors and does not necessarily represent the policy or views of the NIH, NCATS, or the United States Government. This work was also supported in part by the Initiative for Multicenter Pragmatic Anesthesiology Clinical Trials (IMPACT) Award to Dr. Schonberger.
Funding Information:
This work was supported in part by CTSA Grant UL1 RR024139 from the National Center for Advancing Translational Sciences (NCATS). The content is solely the responsibility of the authors and does not necessarily represent the policy or views of the NIH, NCATS, or the United States Government. This work was also supported in part by the Initiative for Multicenter Pragmatic Anesthesiology Clinical Trials (IMPACT) Award to Dr. Schonberger. Dr. Schonberger discloses that he holds an equity stake in Johnson = Johnson, a publicly traded, diversified manufacturer of healthcare products. No industry funding was obtained for the present research.
Publisher Copyright:
© 2020 The Authors
PY - 2020/6
Y1 - 2020/6
N2 - Although statins are highly effective for reducing cardiovascular disease events, prior studies demonstrate their significant underuse in the US population, including among those with known atherosclerotic disease. It is unknown whether this finding applies to the subset of patients who present for outpatient surgery, as such patients would be expected to have recent exposures to healthcare providers during the preoperative referral period. The primary aim of this manuscript was to ascertain the prevalence of statin underuse and associated risk-factors for such underuse among ambulatory surgical patients with documented atherosclerotic cardiovascular disease. This was a retrospective observational study of a random sample of 600 patients ages 40–75 years presenting for ambulatory surgery within a 6-month period in 2016, at one of three ambulatory surgical centers affiliated with a large, tertiary care hospital. Compilation and analysis of data occurred in 2018–2019. Of the 600 subjects, 117 (19.5%) had documented atherosclerotic cardiovascular disease. Within this high-risk group, only 71 (60.7%) carried a prescription for any statin, and only 30 (25.6%) were prescribed a recommended high intensity statin dose for secondary prevention. In a multivariable logistic regression analysis, older age, male sex, and treatment for hypertension were positively associated with statin use. In conclusion, statin underuse among ambulatory surgical patients is common and mirrors what has been observed in non-surgical populations. Future trials are needed to investigate the possible role of surgical teams to promote guideline-based statin therapy, including the role of preoperative screening interventions to impact long term cardiovascular morbidity and mortality.
AB - Although statins are highly effective for reducing cardiovascular disease events, prior studies demonstrate their significant underuse in the US population, including among those with known atherosclerotic disease. It is unknown whether this finding applies to the subset of patients who present for outpatient surgery, as such patients would be expected to have recent exposures to healthcare providers during the preoperative referral period. The primary aim of this manuscript was to ascertain the prevalence of statin underuse and associated risk-factors for such underuse among ambulatory surgical patients with documented atherosclerotic cardiovascular disease. This was a retrospective observational study of a random sample of 600 patients ages 40–75 years presenting for ambulatory surgery within a 6-month period in 2016, at one of three ambulatory surgical centers affiliated with a large, tertiary care hospital. Compilation and analysis of data occurred in 2018–2019. Of the 600 subjects, 117 (19.5%) had documented atherosclerotic cardiovascular disease. Within this high-risk group, only 71 (60.7%) carried a prescription for any statin, and only 30 (25.6%) were prescribed a recommended high intensity statin dose for secondary prevention. In a multivariable logistic regression analysis, older age, male sex, and treatment for hypertension were positively associated with statin use. In conclusion, statin underuse among ambulatory surgical patients is common and mirrors what has been observed in non-surgical populations. Future trials are needed to investigate the possible role of surgical teams to promote guideline-based statin therapy, including the role of preoperative screening interventions to impact long term cardiovascular morbidity and mortality.
KW - Hydroxymethylglutaryl-CoA reductase inhibitors
KW - Perioperative care
KW - Preventive medicine
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U2 - 10.1016/j.pmedr.2020.101085
DO - 10.1016/j.pmedr.2020.101085
M3 - Article
AN - SCOPUS:85083560042
VL - 18
JO - Preventive Medicine Reports
JF - Preventive Medicine Reports
SN - 2211-3355
M1 - 101085
ER -