For decades, patients with high cholesterol have relied on statins to lower cholesterol levels and reduce risk of complications. Not only have statins been well studied, their widespread use has helped decrease heart attack and stroke among patients with heart disease.
However, the recent development of non-statin cholesterol-lowering drugs has opened up new treatment options for patients with heart disease. Many patients now take statins in addition to non-statin lipid therapy to reduce cardiovascular risk. Those who can’t tolerate statins due to side effects often take non-statins as an alternative to traditional therapy. But clinical trials have raised concerns about these new drugs, leading to a decline in their use.
To measure changes in the use of cholesterol-lowering drugs, researchers analyzed medication use among Medicare patients between 2007 and 2011 and recently published in the Journal of the American College of Cardiology. The study included more than 310,000 adults aged 65 years or older, many of whom were being treated with cholesterol-lowering statins and non-statin drugs.
Researchers tracked the use of seven statins (atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin) and four non-statin medications (ezetimibe, fibrates, niacin and bile acid sequestriants).
After analyzing results, researchers found that statin use was extremely common among Medicare patients. More than half of patients with heart disease were on statins, and between 2007 and 2011 statin use in this group increased from 53% to 59%.
Non-statin use, however, was much less common among study participants. Very few patients took fibrates, niacin or bile acid sequestriants, and there was little change in usage of these drugs during the study period. At its peak, ezetimibe was used by 12% of patients, but by 2007, less than 5% of patients took this drug.
Overall, non-statin therapy was less common among older adults and African-Americans and more common among men, patients with diabetes and patients taking statins.
Based on findings, researchers conclude that non-statin use is uncommon among older adults living with heart disease. As authors explain, their decreased use is likely due to negative findings from recent clinical trials. Since cholesterol-lowering drugs can help significantly improve outcomes in patients with heart disease, authors encourage future studies on the issue. Statins and non-statins can improve outcomes in patients with heart disease, but additional research is needed to understand which patients benefit most from these treatments.