Prescribing pattern of lipid-lowering medications before and after adoption of 2013 american college of cardiology and american heart association guidelines in Thailand: An interrupted time series analysis

Abstract

The American College of Cardiology (ACC) and the American Heart Association (AHA) in 2013 introduced new Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (2013 ACC/AHA guideline) focusing on use of appropriate statins as first-line drugs to reduce risks of atherosclerotic cardiovascular diseases (ASCVD). The 2013 ACC/AHA guideline was adopted in Thailand in November 2013. Impact of the new guidelines on statin use in the country was assessed by examining changes in prescribing patterns of lipid-lowering agents (LLAs) pre-and post-2013 ACC/AHA guideline release using an interrupted time series (ITS) design with segmented regression analysis. Health records of patients ≥21 years of age were collected from three tertiary-care hospitals in Thailand. ITS analysis carried out on 1,597,346 LLA prescriptions of 133,212 patients revealed a statistically significant increase in prescribed high-intensity statins post-compared to pre-2013 ACC/AHA guideline release for all patients in the three study hospitals, including those with ASCVD, diabetes and primary LDL cholesterol ≥190 mg/dL (p-value <0.001 for all categories). In addition, post-2013 ACC/AHA guideline prescriptions transited from low-or moderate-to high-intensity statins. Thus, the significant rise in trend of prescribing high-intensity statins would suggest a positive impact on prescriber good practice in tertiary-care hospitals of Thailand as a result of adopting the 2013 ACC/AHA guideline.