Millions of Americans eligible for cholesterol-lowering medications are not taking them, potentially missing out on lifesaving prevention and billions in healthcare savings.
A significant number of eligible patients in the United States are not taking cholesterol-lowering medications like statins, despite recommendations that they should. Led by Johns Hopkins, the study highlights a large treatment gap between those who qualify for these drugs and those who actually use them (1✔ ✔Trusted Source
US Public Health Gains from Improved Treatment of Hypercholesterolemia: A Simulation Study of NHANES Adults Treated to Guideline-Directed Therapy
).
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Persistent Gaps Despite Proven Therapies
Coronary artery disease remains a leading cause of death in the U.S. and globally, despite the development of statins and other cholesterol-lowering medications in recent decades. Many adults who should be taking these drugs to lower their low-density-lipoprotein (LDL) levels are not—even though these drugs are considered safe and there is a large body of evidence supporting their effectiveness. In their new study, the researchers sought to quantify this treatment gap.
In a nationally representative analysis of nearly 5,000 U.S. adults, the researchers found that among those who had never had a major cardiovascular event, just under half—47% were eligible for cholesterol-lowering drugs under U.S. guidelines but only 23% were taking them.
Among those who had a record of a major cardiovascular event, just over two-thirds—68% were receiving cholesterol-lowering treatment when 100% were eligible for them under 2018 U.S. guidelines.
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Missed Prevention Opportunities and Healthcare Costs
The researchers estimate that closing this treatment gap could help prevent nearly 100,000 non-fatal heart attacks in the U.S. each year and up to 65,000 strokes overall in the U.S. each year, and also prevent tens of thousands of heart bypass surgeries and stent-placement procedures annually in the U.S.
Bringing treatment in line with recommended U.S. guidelines could save up to $30.6 billion in annual medical costs in the U.S. for these prevented events, the researchers estimate.
The findings were published online June 30 in the Journal of General Internal Medicine.
“These results add to a growing body of evidence that there are important shortcomings in the quality of care for common and costly chronic diseases such as high cholesterol, and that addressing those shortcomings would yield major public health benefits,” says study lead author G. Caleb Alexander, MD, a practicing internist and professor in the Johns Hopkins Bloomberg School of Public Health’s Department of Epidemiology.
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Data Analysis from National Health Surveys
For their study, the researchers analyzed data on a nationally representative sample of 4,980 American adults, ages 40–75, from U.S. National Health and Nutrition Examination Surveys taken from 2013 to 2020. The researchers used data for each individual that included LDL-cholesterol levels and cardiovascular risk profiles to determine eligibility for lipid-lowering medications based on 2018 U.S. guidelines, as well as actual use of such medications by U.S. patients.
The researchers also analyzed U.S. patient data applying E.U. guidelines. The European guidelines had more aggressive LDL-C goals compared to U.S. guidelines, resulting in wider gaps between observed and recommend care.
Prevention Gaps by Risk Category
The vast majority of the individuals in the sample—89% didn’t have a record of a major cardiovascular event such as a stroke, heart attack, or coronary bypass surgery. In this “primary prevention” group, representing about 116 million U.S. adults, only 23% were using lipid-lowering drugs to prevent such events, although 47% were eligible for such drugs under U.S. guidelines.
Among the 11% of the sample who did have a record of a major cardiovascular event—a “secondary prevention” sample representing about 15 million U.S. adults—only 68% received any LDL-lowering treatment, despite 100% being eligible under both the U.S. and E.U guidelines examined.
Potential Impact of Improved Treatment Rates
The researchers estimated that if treatment for all eligible individuals were fully aligned with U.S. or E.U. guidelines, including the use of non-statin LDL-lowering drugs in many cases, median levels of LDL cholesterol would drop sharply, reducing the risk of major cardiovascular events in the U.S. by up to 27%.
“Several factors account for the gaps that we document,” says Alexander. “They include differences in clinician training, patient preferences, barriers to accessing care, financial incentives that don’t always support best practices, and the difficulty of putting clinical guidelines into practice in busy, real-world settings.”
Addressing Gaps Through Screening and Education
Bringing actual treatment closer to what guidelines recommend could be achieved through various measures including better patient education on the benefits of treatment for those who know they have high LDL-cholesterol levels, and better screening for everyone else, the researchers say.
“High cholesterol is an important chronic health condition that silently claims far too many lives —there are millions of people walking around with this condition that don’t even know they have it, and then when it is recognized it too often goes undertreated. Evidence-based action is critical to close the gap and prevent devastating cardiovascular events,” says study senior author Seth S. Martin, M.D., MHS, a practicing cardiologist and professor at the Johns Hopkins University School of Medicine.
Reference:
- US Public Health Gains from Improved Treatment of Hypercholesterolemia: A Simulation Study of NHANES Adults Treated to Guideline-Directed Therapy – (https://link.springer.com/article/10.1007/s11606-025-09625-0)
Source-Eurekalert