ABSTRACT
Introduction: Almost 30% of US adults have elevated low-density lipid cholesterol (LDL-C) increasing their risk of atherosclerotic cardiovascular disease (ASCVD). The 2018 American College of Cardiology/American Heart Association Multisociety Cholesterol Guideline recommends maximally tolerated statin for those at increased ASCVD risk and add-on therapies (ezetimibe and PCSK9 inhibitors) for those at very high risk with LDL-C>=70 mg/dl, but prescription fill trends are unknown. Method(s): Using the IQVIA Total Patient Tracker database (covering ~93% of outpatient retail prescriptions in the US) from Q1 2017-Q1 2022, we determined counts of patients who filled low-, moderate-, or high-intensity statins alone and with ezetimibe or PCSK9 inhibitors. Overall percent change and joinpoint regression were used to assess trends. Result(s): From Q1 2017-Q1 2022, patients filling any statin intensity increased 25% with the greatest increase in high-intensity statins (64.1%). Concurrent fills of high-intensity statin and ezetimibe rose 210%, with an increase in slope by Q2 2019 for all statin intensities (p<0.001, Figure A). Patients filling a PCSK9 inhibitor and all statin intensities increased over the study period (2124% for high-intensity), with increases in slope in Q2 2019 and continued increase in fills but less sharp rise in Q1 2020 (p<0.001, Figure B). Conclusion(s): Increasing prescription fills of high-intensity statins and add-on ezetimibe and PCSK9 inhibitors indicate uptake of guideline-concordant lipid-lowering therapies for cardiovascular disease prevention. There is need for continuity of PCSK9 inhibitor therapy which may have been disrupted during COVID-19. (Figure Presented).