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Lipid Testing Trends in the US Before and After the Release of the 2013 Cholesterol Treatment Guidelines.

Publication ,  Journal Article
Levintow, SN; Reading, SR; Saul, BC; Yu, Y; Reams, D; McGrath, LJ; Philip, K; Dluzniewski, PJ; Brookhart, MA
Published in: Clin Epidemiol
2020

BACKGROUND: The 2013 ACC/AHA cholesterol treatment guidelines removed the recommendation to treat adults at risk of cardiovascular disease to goal levels of low-density lipoprotein cholesterol (LDL-C). We anticipated that the frequency of LDL-C testing in clinical practice would decline as a result. To test this hypothesis, we evaluated the frequency of LDL-C testing before and after the guideline release. METHODS: We used the MarketScan® Commercial and Medicare Supplemental claims data (1/1/2007-12/31/2016) to identify four cohorts: 1) statin initiators (any intensity), 2) high-intensity statin initiators, 3) ezetimibe initiators, and 4) patients at very high cardiovascular risk (≥2 hospitalizations for myocardial infarction or ischemic stroke, with prevalent statin use). Rates of LDL-C testing by calendar year quarter were estimated for each cohort. To estimate rates in the absence of a guideline change, we fit a time-series model to the pre-guideline rates and extrapolated to the post-guideline period, adjusting for covariates, seasonality, and time trend. RESULTS: Pre- and post-guideline rates (LDL-C tests per 1,000 persons per quarter) were 248 and 235, respectively, for 3.9 million statin initiators; 263 and 246 for 1.3 million high-intensity statin initiators; 277 and 261 for 323,544 ezetimibe initiators; and 180 and 158 for 42,108 very high-risk patients. For all cohorts, observed post-guideline rates were similar to model-predicted rates. On average, the difference between observed and predicted rates was 8.5 for patients initiating any statin; 2.6 for patients initiating a high-intensity statin; 11.4 for patients initiating ezetimibe, and -0.5 for high-risk patients. CONCLUSION: We observed no discernible impact of the release of the 2013 ACC/AHA guidelines on LDL-C testing rates. Rather, there was a gradual decline in testing rates starting prior to the guideline change and continuing throughout the study period. Our findings suggest that the guidelines had little to no impact on use of LDL-C testing.

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Published In

Clin Epidemiol

DOI

ISSN

1179-1349

Publication Date

2020

Volume

12

Start / End Page

835 / 845

Location

New Zealand

Related Subject Headings

  • 4206 Public health
  • 4202 Epidemiology
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Levintow, S. N., Reading, S. R., Saul, B. C., Yu, Y., Reams, D., McGrath, L. J., … Brookhart, M. A. (2020). Lipid Testing Trends in the US Before and After the Release of the 2013 Cholesterol Treatment Guidelines. Clin Epidemiol, 12, 835–845. https://doi.org/10.2147/CLEP.S259757
Levintow, Sara N., Stephanie R. Reading, Bradley C. Saul, Ying Yu, Diane Reams, Leah J. McGrath, Kiran Philip, Paul J. Dluzniewski, and M Alan Brookhart. “Lipid Testing Trends in the US Before and After the Release of the 2013 Cholesterol Treatment Guidelines.Clin Epidemiol 12 (2020): 835–45. https://doi.org/10.2147/CLEP.S259757.
Levintow SN, Reading SR, Saul BC, Yu Y, Reams D, McGrath LJ, et al. Lipid Testing Trends in the US Before and After the Release of the 2013 Cholesterol Treatment Guidelines. Clin Epidemiol. 2020;12:835–45.
Levintow, Sara N., et al. “Lipid Testing Trends in the US Before and After the Release of the 2013 Cholesterol Treatment Guidelines.Clin Epidemiol, vol. 12, 2020, pp. 835–45. Pubmed, doi:10.2147/CLEP.S259757.
Levintow SN, Reading SR, Saul BC, Yu Y, Reams D, McGrath LJ, Philip K, Dluzniewski PJ, Brookhart MA. Lipid Testing Trends in the US Before and After the Release of the 2013 Cholesterol Treatment Guidelines. Clin Epidemiol. 2020;12:835–845.

Published In

Clin Epidemiol

DOI

ISSN

1179-1349

Publication Date

2020

Volume

12

Start / End Page

835 / 845

Location

New Zealand

Related Subject Headings

  • 4206 Public health
  • 4202 Epidemiology
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences