Lipid Management in US Commercial and Medicare Enrollees with Atherosclerotic Cardiovascular Disease: Treatment Patterns and Low-Density Lipoprotein Cholesterol Control.

Lipid-lowering therapy (LLT) is the cornerstone for secondary prevention of atherosclerotic cardiovascular disease (ASCVD), yet many patients exhibit low adherence to therapy and fail to achieve low-density lipoprotein cholesterol (LDL-C) goals. This retrospective cohort study used 2 nationally representative administrative closed claims databases (PharMetrics® Plus and Medicare Fee-for-Service [FFS] Research Identifiable Files) to identify commercial (C) and Medicare (M) enrollees with ASCVD between 2014-2019. Patients were stratified by exposure to statin therapy, ezetimibe and proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9i mAb) regimens. Outcomes included LLT adherence (proportion of days covered [PDC] ≥0.8), persistence, and discontinuation at 12 months. For patients with LDL-C test results, percent achieving LDL-C <70 mg/dL during follow-up was evaluated. We identified 4.6 million patients with ASCVD (C: 945,704, M: 3,659,011), majority with ischemic or coronary heart disease. Of those, C:66.4% and M:71.4% were on at least 1 LLT, including C:69.8% and M: 71.4% on statin therapy, C: 2.7% and M:1.7%% on ezetimibe, and C:0.2% and M:0.04% on a PCSK9i mAb. By month 12, medication discontinuation was: C:30.4% and M:34.1% for statin therapy, C:35.5% and M:46.1% for ezetimibe and C:41.5%, M:55.8% for PCSK9i mAb. Approximately half of treated patients remained adherent at 12 months. Of patients with LDL-C data available (n=381,160), <20% achieved an LDL-C <70 mg/dL. In conclusion, medication discontinuation and low adherence to statin therapy, ezetimibe, and PCSK9i mAb were seen in both populations. Increased efforts are needed to ensure persistence and adherence to LLT in patients with ASCVD to attain LDL-C targets.