Statin Therapy for Patients With Cardiovascular Disease (SPC-E)

The percentage of persons 21–75 years of age during the measurement period who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) and met the following criteria. Two rates are reported: 

  1. Received Statin Therapy. Persons who were dispensed at least one high-intensity or moderate-intensity statin medication during the measurement period.
  2. Statin Adherence 80%. Persons who remained on a high-intensity or moderate-intensity statin medication for at least 80% of the treatment period.

Why It Matters

Cardiovascular disease (CVD), including coronary heart disease, heart failure, stroke, and hypertension, is the leading cause of death in the United States. Between 2019 and 2022 the death rate due to cardiovascular disease has increased from 200.8 per 100,000 to 210.9 per 100,000 1. Likewise, the public health burden remains significant. More than 127.9 million (48.6%) American adults have one or more types of cardiovascular disease 2. National initiatives to improve cardiovascular health include the Million Hearts initiative to prevent 1 million heart attacks and strokes within 5 years by 2027 3 and the American Heart Association (AHA) goal to increase healthy life expectancy from 66 years of age to at least 68 years of age across the United States by 2030 4.

Atherosclerotic cardiovascular disease (ASCVD) is a systemic disease that occurs when plaque builds up within the walls of arteries. Cholesterol is a primary causal risk factor for the development of atherosclerosis and CVD as, plaque consists of fat, calcium, inflammatory cells and scar tissue that can harden overtime and narrow arteries. The narrowing of arteries reduces the flow of oxygen to organs and throughout the body, which results in most cardiovascular events, including heart attack and stroke 5. Low-density lipoprotein cholesterol (LDL-C) is most closely associated with CVD risk and therefore is the target of both lifestyle and pharmacological treatment 2.

Coronary heart disease (CHD) occurs when plaque builds up in arteries that supply oxygen to the heart 5. An estimated 20.5 million Americans 20 years of age and older have CHD, and the prevalence is higher for males than females 2. Plaque buildup can lead to peripheral arterial disease, which results when plaque builds up in arteries that supply oxygen to the legs, arms and pelvis. About 6.5 million adults 40 years of age and older have peripheral artery disease. The prevalence is higher in older adults and non-Hispanic Black individuals 2.

A myocardial infarction (heart attack) occurs when oxygen rich blood is suddenly blocked from reaching the heart. Approximately 3.2% of US adults 20 and older have had a myocardial infarction; the rate is more than twice as high in men (4.5%) than in women (2.1%). Data show that about 14% of people with myocardial infarction will die from it 2.

Statins (HMG CoA reductase inhibitors) are a class of drugs that lower blood cholesterol. Statins work in the liver by reducing the formation of cholesterol, and help the liver remove cholesterol already in the blood 6. Statins are most effective in lowering low-density lipoprotein cholesterol (LDL-C). The amount of cholesterol lowering effect is based on statin intensity, which is classified as either high, moderate or low intensity.

According to the most recent blood cholesterol treatment guidelines from the American College of Cardiology and American Heart Association (ACC/AHA), statins of moderate or high intensity are recommended for adults with established clinical ASCVD. Many studies support the use of statins to reduce ASCVD events in primary and secondary prevention.

One systemic review observed large-scale evidence from randomized trials that showed statin therapy reduces the risk of major cardiovascular events like coronary deaths, MI, and stroke. The benefits of statins are shown to increase during each year therapy continues so larger benefits would accrue with prolonged therapy and persist long term 7.

Historical Results – National Averages

Performance results for this measure are currently unavailable.

References

  1. Centers for Disease Control and Prevention. (n.d.). Underlying Cause of Death, 2018-2022, Single Race Results Form. Retrieved June 28, 2024, from https://wonder.cdc.gov/controller/datarequest/D158;jsessionid=B102CD84AF279A85C54277580EEF
  2. Martin, S., Aday, A. W., Almazooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Barone Gibbs, B., Beaton, A. Z., Boheme, A. K., Commodore-Mensah, Y., Currie, M. E., & Elkind, M. 2024. “Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.” https://doi.org/10.1161/CIR.0000000000001209
  3. CDC. 2024. “Million Hearts®.” Centers for Disease Control and Prevention. April 11, 2024. https://millionhearts.hhs.gov/index.html
  4. Angell, S. Y., McConnell, M. V., Anderson, C. A. M., Bibbins-Domingo, K., Boyle, D. S., Capewell, S., Ezzati, M., de Ferranti, S., Gaskin, D. J., Goetzel, R. Z., Huffman, M. D., Jones, M., Khan, Y. M., Kim, S., Kumanyika, S. K., McCray, A. T., Merritt, R. K., Milstein, B., Mozaffarian, D., … Warner, J. J. 2020. “The American Heart Association 2030 Impact Goal: A Presidential Advisory From the American Heart Association.” Circulation, 141(9), e120–e138. https://doi.org/10.1161/CIR.0000000000000758
  5. American Heart Association. 2024. “What Does ASCVD Mean?” https://www.heart.org/-/media/Files/Health-Topics/Cholesterol/What-is-ASCVD.pdf?sc_lang=en#:~:text=Page%201-,What%20does%20ASCVD%20mean?,of%20blood%20to%20important%20organs
  6. CDC. 2021. “Million Hearts® The Scoop on Statins.” Centers for Disease Control and Prevention. September 27, 2021. https://millionhearts.hhs.gov/learn-prevent/scoop-on-statins.html
  7. Collins, R., Reith, C., Emberson, J., Armitage, J., Baigent, C., Blackwell, L., Blumenthal, R., Danesh, J., Smith, G. D., DeMets, D., Evans, S., Law, M., MacMahon, S., Martin, S., Neal, B., Poulter, N., Preiss, D., Ridker, P., Roberts, I., … Peto, R. 2016. “Interpretation of the Evidence for the Efficacy and Safety of Statin Therapy.” The Lancet, 388(10059), 2532–2561. https://doi.org/10.1016/S0140-6736(16)31357-5

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