Statins – HMG-CoA Reductase Inhibitors

High cholesterol is a significant risk factor for cardiovascular disease (CVD) and specifically for coronary heart disease (CHD).
Cardiovascular disease is the leading cause of death in the U.S. In fact, it kills more Americans each year than all cancers combined. Approximately 17% of all national healthcare spending focuses on this disease alone.
By 2030, approximately 40% of the U.S. population is expected to have some form of CVD. As a result, direct medical costs for CVD in the U.S. are expected to triple from $273 billion currently to $818 billion in 2030. Indirect costs, due to lost productivity, are projected to increase by approximately 60% in the same period, from $172 billion to $276 billion. Overall, the total costs of CVD will more than double over the next 20 years, to well over a trillion dollars.
Estimated Statin Usage Among US Population
Estimated % of US Population with Cardiovascular Disease by 2030
% of Patients Who Discontinued Usage Due to Side Effects
Overall, statin use among US adults 40 years of age and older in the general population increased 79.8% from 21.8 million individuals (17.9%) in 2002-2003 (134 million prescriptions) to 39.2 million individuals (27.8%) in 2012-2013 (221 million prescriptions). Overall, statin use increased by 79% among the US adult population, rising from 17.9% to 27.8% from 2002-2003 to 2012-2013.
While these figures represent modest success in improving statin uptake in the general population, the trends in high-risk groups, such as those with
atherosclerotic cardiovascular disease (ASCVD) and diabetes, remain suboptimal. Since 2004-2005, statin use in those with CHD essentially remained unchanged, increasing slightly from 60% to 63%.
This finding is consistent with insights from National Health and Nutrition Examination Survey data showing that only 60% of US adults with CHD were taking lipid-lowering medications in 2005-2006 compared with 70.8% in 2012. Similar trends were noted in Medicare patients with CHD, who also showed a modest rise in statin use from 61% in 2004 to 66% in 2007-2008.


Factors noted to be associated with reduced uptake of appropriate high-intensity statin use include patient concerns regarding adverse effects.
The suboptimal use of intensive statin therapy among 21.9 million US adults raises concerns about missed opportunities for intensive prevention in high-risk patients and highlights an important opportunity to improve care and reduce recommended treatment gaps.
Some investigators nowadays suggest that 10–20% of patients are unable to tolerate statins, either completely or at a higher dose. Consequently, poor adherence in the real-world setting has become an important problem. With statins, the reported rate of adverse events differs widely between randomized clinical trials (RCTs) and observations in clinical practice, the rates being 1–2% in RCTs vs. 10–20% in the so-called real world.