Statin Therapy for Patients with Cardiovascular Disease (SPC)

This measure assesses the percentage of males 21–75 years of age and females 40–75 years of age who were identified as having clinical atherosclerotic cardiovascular disease (ASCVD) who met the following criteria. The following rates are reported:

1. Received Statin Therapy. Members who were dispensed at least one high- or moderate-intensity statin medication.
2. Statin Adherence 80%. Members who remained on a high- or moderate-intensity statin medication for at least 80% of the treatment period.

Why it Matters

Cardiovascular disease is the leading cause of death in the United States. More than 121 million American adults have one or more types of cardiovascular disease and it is estimated that, by 2035, more than 45% of Americans will have a form of cardiovascular disease.¹ In 2014–2015, the total cost of cardiovascular disease in the United States was estimated to be $351B. This total includes direct costs, such as the cost of physicians and other health professionals, hospital services, prescribed medications and home health care, as well as indirect costs due to loss of productivity from premature mortality.²

The number of interventions to address cardiovascular disease is increasing: From 2000–2010, inpatient cardiovascular operations and procedures increased by 28%, from 5,939,000 to 7,588,000.³ By 2035, total medical costs for cardiovascular disease are projected to increase to $1 trillion.

Statins are a class of drugs that lower blood cholesterol. Statins work in the liver by preventing the formation of cholesterol, thus lowering the amount of cholesterol in the blood.⁴ Statins are most effective in lowering low-density lipoprotein cholesterol (LDL-C). The degree of cholesterol-lowering effect is based on statin intensity, which is classified as either high, moderate or low.

Statins are among the most commonly prescribed medications in the United States. A study of noninstitutionalized adults over 40 years of age estimated that there were 818 million prescriptions for statins, amounting to $10B in costs and $3.1B in out-of-pocket expenditures in 2019.⁵ According to recent blood cholesterol treatment guidelines from the American College of Cardiology and American Heart Association (ACC/AHA), statins of moderate or high intensity are recommended for adults with established clinical ASCVD. Many studies support the use of statins to reduce ASCVD events in primary and secondary prevention.

One meta-analysis of data from 170,000 patients in 26 randomized controlled trials found that intensive statin therapy reduces major vascular events by 15%.⁶ The study also found a 13% reduction in coronary death or nonfatal myocardial infarction, a 19% reduction in coronary revascularization and a 16% reduction in ischemic stroke.⁶ Similarly, a more recent meta-analysis found that statin therapy or a more intensive statin regimen was associated with a 21% proportional reduction in major vascular events per 1.0 unit (mmol/L) reduction in LDL-C.⁷

Another systematic review and meta-analysis estimates that long term statin therapy reduces the risk for ASCVD events by 25%–45%.⁸

Historical Results – National Averages

§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.