Clinical Epidemiology (Jun 2022)
Lipid Testing Trends Before and After Hospitalization for Myocardial Infarction Among Adults in the United States, 2008–2019
Abstract
Sara N Levintow,1,2 Stephanie R Reading,3 Sina Noshad,3 Sophie E Mayer,1,2 Catherine Wiener,1 Bassim Eledath,1 Jason Exter,3 M Alan Brookhart1,4 1NoviSci, Inc., Durham, NC, USA; 2Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 3Amgen, Inc., Thousand Oaks, CA, USA; 4Department of Population Health Sciences, Duke University, Durham, NC, USACorrespondence: Sara N Levintow, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, Email [email protected]: Routine monitoring of low-density lipoprotein cholesterol (LDL-C) identifies patients who may benefit from modifying lipid-lowering therapies (LLT). However, the extent to which LDL-C testing is occurring in clinical practice is unclear, specifically among patients hospitalized for a myocardial infarction (MI).Methods: Using US commercial claims data, we identified patients with an incident MI hospitalization between 01/01/2008-03/31/2019. LDL-C testing was assessed in the year before admission (pre-MI) and the year after discharge (post-MI). Changes in LDL-C testing were evaluated using a Poisson model fit to pre-MI rates and extrapolated to the post-MI period. We predicted LDL-C testing rates if no MI had occurred (ie, based on pre-MI trends) and estimated rate differences and ratios (contrasting observed vs predicted rates).Results: Overall, 389,367 patients were hospitalized for their first MI during the study period. In the month following discharge, 9% received LDL-C testing, increasing to 27% at 3 months and 52% at 12 months. Mean rates (tests per 1000 patients per month) in the pre- and post-MI periods were 51.9 (95% CI: 51.7, 52.1) and 84.4 (95% CI: 84.1, 84.6), respectively. Over 12 months post-MI, observed rates were higher than predicted rates; the maximum rate difference was 66 tests per 1000 patients in month 2 (rate ratio 2.2), stabilizing at a difference of 15– 20 (ratio 1.2– 1.3) for months 6– 12.Conclusion: Although LDL-C testing increased following MI hospitalization, rates remained lower than recommended by clinical guidelines. This highlights a potential gap in care, where increased LDL-C testing after MI may provide opportunities for LLT modification and decrease risk of subsequent cardiovascular events.Keywords: low-density lipoprotein cholesterol, myocardial infarction, statin, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors
