Introduction: The 2013 American College of Cardiology /American Heart Association (ACC/AHA) blood cholesterol guideline recommends high intensity statin therapy among certain groups of patients, but full implementation of the guideline has not yet been satisfactory.
Hypothesis: High intensity statin therapy among veterans who had a PCI procedure would be underutilized which could result in an excess of avoidable atherosclerotic cardiovascular events
Methods: A retrospective cohort study was conducted at the VHA system including all patients above 18 years old who had their PCI procedure between October 2010 and September 2016. National VHA databases were used to retrieve study participant’s demographics, comorbid conditions, statin type and dose within 90 days before and after the PCI procedure. Projected 10-year risk of atherosclerotic cardiovascular disease (ASCVD) events if cohort would have received high intensity statin therapy vs moderate intensity statin therapy was estimated.
Results: There were 48,862 patients who underwent a PCI procedure during the study period between October 2010 and September 2016. Most patients were male (98.2%), predominantly white (80.6%), and the mean age was 68.9 years ± 9.3 years standard deviation. High intensity statin use at 90 days post-PCI rose from 23% in 2010 to 37% before release of the 2013 ACC/AHA cholesterol guideline, then rose sharply to 80% by 2016. The projected 10 -year risk of ASCVD events among our study population was projected to be approximately 1841 fewer if the cohort had received high intensity statin therapy vs moderate intensity statin.
Conclusions: By 2016, the 2013 ACC/AHA blood cholesterol guideline was exceptionally well implemented among veterans who had a PCI procedure in the VHA system, suggesting systems of care can be improved to increase rates of high intensity statin initiation.