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Research ArticleOriginal ResearchA

Cardiovascular Risk and Statin Use in the United States

Michael Edward Johansen, Lee A. Green, Ananda Sen, Sheetal Kircher and Caroline R. Richardson
The Annals of Family Medicine May 2014, 12 (3) 215-223; DOI: https://doi.org/10.1370/afm.1641
Michael Edward Johansen
1Department of Family Medicine, The Ohio State University, Columbus, Ohio
2Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
MD, MS
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  • For correspondence: Michael.Johansen@osumc.edu
Lee A. Green
2Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
3Department of Family Medicine, University of Alberta, Alberta, Canada
MD, MPH
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Ananda Sen
2Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
4Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
PhD
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Sheetal Kircher
5Department of Internal Medicine, Hematology Oncology, Northwestern University, Evanston, Illinois
MD, MS
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Caroline R. Richardson
2Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
6VA Ann Arbor Health Care System, Ann Arbor, Michigan
7VA Center for Clinical Management Research, Ann Arbor, Michigan
MD, MS
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The Article in Brief

Cardiovascular Risk and Statin Use in the United States: A Cross-Sectional Analysis

Michael E. Johansen , and colleagues

Background New guidelines from the American College of Cardiology and American Heart Association substantially broaden the number of individuals for whom statin medications are recommended, primarily by expanding the eligible population to lower levels of cardiovascular risk. This study examines the relationships between statin use and cardiovascular risk, diagnosis of hyperlipidemia (high cholesterol and triglyceride levels), and other risk factors.

What This Study Found Many people at high risk for cardiovascular disease, including those with coronary artery disease, diabetes or both, are not receiving statins. An estimated nine million people over 40 years of age with diabetes and 5.6 million people with coronary artery disease--populations that have clearly been shown to benefit from the drugs--are not on statins. Those with high cholesterol but without diabetes or heart disease are more likely to be on statins than those without high cholesterol but who have diabetes or heart disease. Given that individuals with heart disease or diabetes are at considerably higher cardiovascular risk, this pattern strongly supports the notion that statin use is being driven by high cholesterol instead of by overall cardiovascular risk.

Implications

  • Recently released ACC-AHA guidelines offer an opportunity to reframe statins as medications that reduce cardiovascular risk rather than as medications that lower cholesterol.

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