Premature ASCVD Patients Less Likely to Use and Adhere to Statins, Aspirin

August 21, 2020
Jonathan Alicea

Results of the study suggest that patients with premature and extremely premature ASCVD are at risk for a higher accrued lifetime morbidity.

Patients with premature or extremely premature atherosclerotic cardiovascular disease (ASCVD) were less likely to rely on aspirin or statin therapy.

These findings are especially significant considering that the incidence of ASCVD has increased in younger patients. These troubling trends are found across cases of ischemic disease, ischemic cerebrovascular disease, and peripheral arterial disease, all of which are considered to be domains of ASCVD and which the investigators assessed.

The team, led by Dhruv Mahtta, DO, MBA, of Baylor College of Medicine, evaluated and compared aspirin use, statin use, and high-intensity statin use, and statin adherence among premature and extremely premature ASCVD. They then compared the data with nonpremature ASCVD patients.

They defined premature ASCVD as the first disease-related event occurring at <55 years for men and <65 years for women. Extremely premature was defined as first event occurring at <40 for both men and women.

Using clinical and data sets available through the US Department of Veteran Affairs, the investigators identified approximately 1.25 million patients with ASCVD. Of the entire total, 10.9% had premature ASCVD (mean age, 49.6) with 0.6% having extremely premature ASCVD (mean age, 34.2).

Mean nonpremature ASCVD age for the remaining 89.1% was 69.6 years.

Within the premature ASCVD and extremely premature populations, 86.0% and 85.2% were men, respectively.

Results from the multicenter cross-sectional study found that premature ASCVD patients had lower rates of use and adherence to secondary prevention therapies when compared with nonpremature patients. This was seen in aspirin use (71.1% vs 77.4%; P <.001), and any statin use (72.2% vs 80.5%; P <.001).

Investigators also noted that premature patients had a statin PDC of 0.8 or higher (57.9% vs 72.0%; P <.001).

However, they had a higher rate of high-intensity statin use (36.4% vs 29.9%; P <.001).

Thus, in fully adjusted regression models, premature ASCVD was independently associated with 37% higher likelihood of high-intensity use (OR, 1.37; 95% CI, 1.35-1.39).

When assessing patients with extremely premature ASCVD, they found that that they less likely to use aspirin (OR, 0.27; 95% CI, 0.26-0.29), statin (OR, 0.25; 95% CI, 0.24-0.27), high-intensity statin (OR, 0.78; 95% CI, 0.74-0.82), and be statin adherent (OR, 0.44; 95% CI, 0.41-0.47).

Mahtta and team acknowledged that therapeutic inertia, defined as the lack of initiation or intensification of clinically indicated treatment, may be a contributing factor in these observed disparities between groups, among other factors.

“Despite guideline recommendations, secondary prevention use of aspirin and statins remained suboptimal in younger patients with premature or extremely premature ASCVD,” the investigators wrote. “Further research into premature ASCVD, clinician and patient education, and policy implementation are necessary to better comprehend and mitigate the disparities in medication use and adherence.”

The study, “Evaluation of Aspirin and Statin Therapy Use and Adherence in Patients With Premature Atherosclerotic Cardiovascular Disease,” was published online in JAMA Network Open.