S1239 Utilization of Statins in Primary Care Patients With Chronic Liver Disease

Introduction: Statins have historically been underutilized in patients with chronic liver disease (CLD) despite studies illustrating their safety and potential benefits in this population. We sought to investigate the association between CLD and statin prescription in a primary care setting. Methods: This retrospective cohort study comprised of electronic health record data from a patient-centered medical home identified primary care patients with a low-density lipoprotein value and more than one office visit from 2012 through 2018. Individuals prescribed a statin from July 2012 to June 2013 were excluded. Indication for statin therapy was determined using the Third Adult Treatment Panel criteria prior to November 2016 and the atherosclerotic cardiovascular disease risk assessment according to the American College of Cardiology and the American Heart Association guidelines thereafter. Indication for statin prescription and statin therapy by year was determined. Patients with CLD were identified using ICD-9/10 codes. Univariate analyses were done using chi-square and student’s t test to identify variables that predicted statin prescription. Logistic regression models were constructed using the CLD status as well as significant predictor variables from the univariate analyses. Results: 2,119 individuals with an indication for statin therapy were identified. Of these individuals, 354 had CLD. Alcoholic and nonalcoholic fatty liver disease comprised 44.92% and 28.53% of the CLD population, respectively; 27.68% had cirrhosis. The presence of CLD did not significantly influence the decision to prescribe a statin (57.85% vs 59.89%, p=0.48). A diagnosis of CLD was not significantly associated with statin prescription when adjusting for other covariates (OR 1.02; 95% CI 0.78-1.33) (Table). An alanine aminotransferase (ALT) level greater than 45 was a negative predictor of statin prescription (OR 0.62, 95% CI 0.44-0.87). Conclusion: In a primary care cohort consisting of individuals with an indication for statin therapy, the presence of CLD did not significantly hinder statin utilization compared to those without a CLD diagnosis. Rather, providers were more conscientious of ALT values. Overall, this study suggests a deviation from historic provider tendencies to avoid statins in CLD patients. Nevertheless, adherence to guideline indicated statin therapy remains suboptimal and efforts to increase statin utilization in this high-risk population remains prudent. Table 1. - Estimated odds ratios and 95% confidence intervals for logistic regression models for the outcome of receiving a prescription for a statin Model 1 Model 2 Model 3 Predictors OR 95% CI OR 95% CI OR 95% CI CLD 0.96 0.75-1.22 0.87 0.67-1.12 1.02 0.78-1.33 Age 0.99 0.98-1.00 1.00 0.99-1.01 1.00 0.99-1.01 Male 1.03 0.86-1.24 1.36 1.12-1.66 1.43 1.18-1.75 Black 1.81 1.51-2.17 1.70 1.39-2.08 1.66 1.35-2.03 Coronary artery disease 2.12 1.38-3.25 1.97 1.26-3.07 1.99 1.28-3.11 Cerebrovascular disease 1.96 1.46-2.63 1.92 1.42-2.61 1.91 1.40-2.60 Congestive heart failure 1.53 1.10-2.13 1.28 0.91-1.81 1.34 0.95-1.90 Diabetes 1.95 1.56-2.43 1.99 1.59-2.49 Hypertension 2.40 1.85-3.10 2.42 1.87-3.14 LDL >160 2.67 2.14-3.32 2.72 2.18-3.40 HDL < 40 0.94 0.75-1.18 0.95 0.75-1.19 Triglycerides >200 1.56 1.18-2.07 1.61 1.21-2.15 ALT >45 0.62 0.44-0.87 Platelets < 140 0.57 0.36-0.92 Bilirubin > 1.2 0.83 0.55-1.26