Utilization of high-intensity statins in patients at risk for cardiovascular events: A national cross-sectional study
BACKGROUND:: The 2013 American College of Cardiology/American Heart Association cholesterol guidelines, which identified four groups of patients at risk for atherosclerotic cardiovascular disease events, departed from the target-based approach to managing cholesterol. The impact of these guidelines on high-intensity statin use across the United States is unclear. STUDY QUESTION:: The primary objective was to evaluate the rate of high-intensity potential (HIP) statin use before and after the 2013 guidelines. The secondary objective was to identify predictors of HIP statin use within the study population. STUDY DESIGN:: A national cross-sectional study was conducted using data from the National Ambulatory Medical Care Survey. Office visits involving patients aged 21–75 years where criteria for HIP statin therapy were met were included. Visits involving pregnant patients were excluded. MEASURES AND OUTCOMES:: Prescribing trends of HIP statins were measured from National Ambulatory Medical Care Survey data before and after the 2013 guidelines. Multivariate logistic regression identified variables associated with prescribing HIP statins. RESULTS:: A total of 48,884 visits were included, representing more than 940 million office visits nationally. HIP statins were listed in 9.5% and 16.5% of visits before and after 2013, respectively (odds ratio [OR] 1.88; 95% confidence interval [CI] 1.62–2.20). The strongest predictors of HIP statin use were antihypertensive use (OR 5.38, 95% CI 4.67–6.20), comorbid hyperlipidemia (OR 2.93, 95% CI 2.62–3.29), Black race (OR 0.63, 95% CI 0.49–0.81), and Hispanic ethnicity (OR 0.65, 95% CI 0.52–0.80). CONCLUSIONS:: Prescribing rates for HIP statins increased after the release of the 2013 guidelines. The prescribing rates were lower than expected, especially in Black and Hispanic patients. These observations signify opportunities to improve the quality of care for patients who are at risk for atherosclerotic cardiovascular disease events in the United States.
Moorman JM;Jaclyn B;Leah B;Dugan SE;Lukas E;Gustafson K;Hartzler C;Nathan H;Joshi D;King C;King K;King PK;Pesce A;Prabodh S;Harold S III;Toth J;Unruh A;Walkerly A
American Journal Of Therapeutics
2020
2020-10-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1097/mjt.0000000000001274" target="_blank" rel="noreferrer noopener">10.1097/mjt.0000000000001274</a>
Informed consent: A policy prescription for communicating benefit and risk in state medical marijuana programs
Drug-Related Side Effects and Adverse Reactions; Cannabis; Information Dissemination; Marijuana Use; Medical Marijuana; Policy Making
In creating medical marijuana laws, state governments signal to the public that marijuana can safely and effectively treat a wide range of diseases. In many cases, these state approvals overestimate the benefits of marijuana and understate the risks. After a comprehensive review of the medical literature, the National Academies of Sciences, Engineering, and Medicine identified six medical benefits from marijuana that were supported with at least a moderate level of medical evidence and 14 potential health hazards. In contrast, the average state medical marijuana program lists 18 medical benefits, and 24 state medical marijuana program websites say nothing about possible risks. Medication approval processes through the federal government traditionally require independent analysis of data from well-designed clinical trials that measure the effectiveness and capture the risks of adverse effects from specific doses of the medicine. These considerations are generally missing from state approvals of medical marijuana. The power to declare something to be a legitimate medicine comes with the responsibility to provide information that people need to use the medicine wisely. The authors recommend that states that declare marijuana to be a medicine should inform the public about the quality of medical evidence behind each approved use and publicize all scientifically credible risks.
Messamore E;Dugan SE
Psychiatric Services
2020
2020-09-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1176/appi.ps.202000140" target="_blank" rel="noreferrer noopener">10.1176/appi.ps.202000140</a>
Informed consent: A policy prescription for communicating benefit and risk in state medical marijuana programs.
Information Dissemination; Policy Making; Medical Marijuana; Drug-Related Side Effects and Adverse Reactions; Cannabis; Marijuana Use
In creating medical marijuana laws, state governments signal to the public that marijuana can safely and effectively treat a wide range of diseases. In many cases, these state approvals overestimate the benefits of marijuana and understate the risks. After a comprehensive review of the medical literature, the National Academies of Sciences, Engineering, and Medicine identified six medical benefits from marijuana that were supported with at least a moderate level of medical evidence and 14 potential health hazards. In contrast, the average state medical marijuana program lists 18 medical benefits, and 24 state medical marijuana program websites say nothing about possible risks. Medication approval processes through the federal government traditionally require independent analysis of data from well-designed clinical trials that measure the effectiveness and capture the risks of adverse effects from specific doses of the medicine. These considerations are generally missing from state approvals of medical marijuana. The power to declare something to be a legitimate medicine comes with the responsibility to provide information that people need to use the medicine wisely. The authors recommend that states that declare marijuana to be a medicine should inform the public about the quality of medical evidence behind each approved use and publicize all scientifically credible risks.
Messamore E; Dugan SE
Psychiatric Services
2020
2020-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1176/appi.ps.202000140" target="_blank" rel="noreferrer noopener">10.1176/appi.ps.202000140</a>