CDC: Half of Those Eligible for Cholesterol Drugs Aren't Taking Them

Nearly half of American adults who could be taking medication to lower low-density lipoprotein (LDL) or “bad” cholesterol are not, according to the current Mortality and Morbidity Weekly Report published by CDC.

The gap is due to expanded guidelines on who should take cholesterol drugs, which were published in late 2013 by the American Heart Association (AHA) and the American College of Cardiology (ACC). While the new recommendations have increased therapy use somewhat, many more could benefit, according to researchers.

“Nearly 800,000 people die in the US each year from cardiovascular disease—that’s 1 in every 3 deaths—and high cholesterol continues to be a major risk factor,” said Carla Mercado, PhD, a scientist in CDC’s Division for Heart Disease and Stroke Prevention and lead author of the study. “This study reveals opportunities to reduce existing disparities through targeted patient education and cholesterol management programs.”

The CDC team examined data from 2005 to 2012 from the National Health and Nutrition Examination Surveys (NHANES). Overall, 36.7% of US adults, or 78.1 million people age 21 or older, met guidelines for cholesterol therapy or were already taking it. Of the group, 55.5% were on medication, 46.6% reported making lifestyle change, 37.1% reported doing both, and 35.5% reported doing neither.

Data revealed that African Americans and Mexican Americans were less likely to be taking cholesterol drugs if they met the guidelines. African Americans and whites were about equally likely to meet the guidelines—39.5% compared with 38.4%--but among those eligible, 58% of whites took medication and only 46% of African Americans did. Only 24.2% of Mexican Americans met the guidelines, and 47.1% of those eligible were taking cholesterol medication.

Fewer women were eligible for medication, but among those who met the guidelines more are taking medication than men.

While the study included all types of cholesterol-lowering medication, 90% of those taking a medication were using a statin. The release of the 2013 guidelines were somewhat controversial, because critics felt they ended up steering too many patients toward statins. The subsequent approval of more powerful cholesterol-fighting therapies, the PCKS9 inhibitors, has caused pharmacy benefit managers to ask the AHA and ACC to go back to the drawing board in light of the cost of these medications.

Updates to the guidelines recommended treatment for the following, based on the risk of a cardiac event using a calculator developed by AHA/ACC:

• People without cardiovascular disease who are 40 to 75 years old and have a 7.5% or higher risk for having a heart attack or stroke within 10 years.
• People with a history of a cardiovascular event (heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization).
• People 21 and older who have a very high level of bad cholesterol (190 mg/dL or higher).
• People with type 1 or type 2 diabetes who are 40 to 75 years old.

Getting 65% of Americans to manage high LDL cholesterol levels by 2017 is a target of HHS, according to a statement from CDC.

Reference

Mercado C, DeSimone AK, Odom E, et al. Prevalence of cholesterol treatment eligibility and medication use among adults—United States, 2005-2012. MMWR 2015;64:1305-1311.