Lipid-Lowering Therapy Use and Intensification among United States Veterans Following Myocardial Infarction or Coronary Revascularization between 2015 and 2019

Alexander R. Zheutlin, Catherine G. Derington, Jennifer S. Herrick, Robert S. Rosenson, Bharat Poudel, Monika M. Safford, Todd M. Brown, Elizabeth A. Jackson, Mark Woodward, Stephanie Reading, Kate Orroth, Jason Exter, Salim S. Virani, Paul Muntner, Adam P. Bress

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background: Understanding how statins, ezetimibe, and PCSK9i (proprotein convertase subtilisin/kexin type 9 serine protease inhibitors) are prescribed after a myocardial infarction (MI) or elective coronary revascularization may improve lipid-lowering therapy (LLT) intensification and reduce recurrent atherosclerotic cardiovascular disease events. We described the use and intensification of LLT among US veterans who had a MI or elective coronary revascularization between July 24, 2015, and December 9, 2019, within 12 months of hospital discharge. Methods: LLT intensification was defined as increasing statin dose, or initiating a statin, ezetimibe, or a PCSK9i, overall and among those with an LDL-C (low-density lipoprotein cholesterol) ≥70 or 100 mg/dL. Poisson regression was used to determine patient characteristics associated with a greater likelihood of LLT intensification following hospitalization for MI or elective coronary revascularization. Results: Among 81 372 index events (mean age, 69.0 years, 2.3% female, mean LDL-C 89.6 mg/dL, 33.8% with LDL-C <70 mg/dL), 39.7% were not taking any LLT, and 22.0%, 37.2%, and 0.6% were taking a low-moderate intensity statin, a high-intensity statin, and ezetimibe, respectively, before MI/coronary revascularization during the study period. Within 14 days, 3 months, and 12 months posthospitalization, 33.3%, 41.9%, and 47.3%, respectively, of veterans received LLT intensification. LLT intensification was most common among veterans taking no LLT (82.5%, n=26 637) before MI/coronary revascularization. Higher baseline LDL-C, having a lipid test, and attending a cardiology visit were each associated with a greater likelihood of LLT intensification, while age ≥75 versus <65 years was associated with a lower likelihood of LLT intensification within 12 months posthospitalization. Conclusions: Less than half of veterans received LLT intensification in the year after MI or coronary revascularization suggesting a missed opportunity to reduce atherosclerotic cardiovascular disease risk.

Original languageEnglish
Pages (from-to)E008861
JournalCirculation: Cardiovascular Quality and Outcomes
Issue number12
Publication statusPublished - 1 Dec 2022
Externally publishedYes


  • cardiovascular disease
  • lipoprotein
  • myocardial infarction
  • secondary prevention
  • veterans


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