Abstract 13025: Lipid Testing Trends in the US Before and After the Release of the 2013 ACC / AHA Cholesterol Guidelines

Introduction:The 2013 ACC/AHA cholesterol treatment guidelines removed the recommendation to treat to blood cholesterol goals for adults with risk of ASCVD. We anticipated that the frequency of lipid testing would decline as a result. To test this hypothesis, we evaluated the frequency of LDL-C testing before and after the release of the 2013 guidelines.Methods:We used the MarketScan Commercial and Medicare Supplemental claims data to identify adults initiating any statin, a high-intensity statin, ezetimibe, and those at high cardiovascular risk (i.e., two MI or IS hospitalizations and statin use). Patients were identified between 1/1/2008 and 12/31/2015 with 12 months of continuous enrollment in a healthcare plan. Rates of LDL-C testing by calendar year quarter were estimated until the first of medication discontinuation, insurance disenrollment, or 12/31/2016. To compare the observed post-guideline rates to those expected, we fit a time-series model to the pre-guideline rates and extrapolated to the post-guideline period, adjusting for covariates, seasonality, and time trend.Results:All rates are given as number of LDL-C tests per 1,000 persons per quarter. The overall pre- and post-guideline unadjusted rates were 248 and 235, respectively, for 3.9 million patients initiating statins; 263 and 246 for 1.3 million patients initiating high-intensity statins; 277 and 261 for 323,544 patients initiating ezetimibe; and 180 and 158 for 42,108 high cardiovascular risk patients. For all patients, the observed post-guideline rates were similar to or slightly higher than the model-predicted rates had no guideline change occurred (Figure).Conclusions:We observed no discernible impact of the release of the 2013 guidelines on LDL-C testing rates. Rather, there was a gradual decline in testing rates from 2008 to 2016. These findings suggest that the 2013 guidelines may have had limited impact on behavioral changes in LDL testing, compared to the ongoing decline.