Increase cholesterol treatment in adults — HDS‑07 Data Methodology and Measurement

Includes non-pregnant fasting adults ≥21 years for whom a statin is recommended, based on their risk for atherosclerotic cardiovascular disease (ASCVD), as defined by the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. (Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC Jr, Watson K, Wilson PWF. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 129 [suppl 2]:S1-S45.)

Those eligible for statin therapy were captured in 4 groups:

1. Clinical ASCVD: Moderate-intensity statin therapy recommended for those aged >75 years; High-intensity statin therapy recommended for those aged 21-75 years. Clinical ASCVD is defined by health care professional's diagnosis of angina, coronary heart disease, heart attack, or stroke or meeting the criteria for grade 1 or grade 2 angina by the Rose questionnaire assessment. The Rose questionnaire is only administered to survey participants aged 40 years and over. Grade 1 angina is defined based on a positive response to ever having had pain or discomfort in chest and ever getting pain or discomfort in chest when walking up hill or in a hurry (but not getting pain or discomfort in chest when walking at an ordinary pace on level ground) and stopping or slowing down if get it while walking and pain or discomfort relieved when standing still, and pain relieved in 10 minutes or less, plus either pain or discomfort located in upper sternum or lower sternum, or left chest and left arm. Grade 2 angina is defined based on positive responses to ever having had pain or discomfort in chest, ever getting pain or discomfort in chest when walking up hill or in a hurry, getting pain or discomfort in chest when walking at an ordinary pace on level ground, stopping or slowing down if get it while walking, pain or discomfort relieved when standing still, and pain relieved in 10 minutes or less, plus either pain or discomfort located in upper sternum or lower sternum, or left chest and left arm.
2. Fasting LDL-c ≥190 mg/dL, no clinical ASCVD (as defined above): High-intensity statin therapy recommended.
3. Aged 40-75 years with diabetes, no clinical ASCVD, and LDL-c 70-189 mg/dL: Moderate-intensity statin therapy recommended for those with a 10-yr risk for ASCVD <7.5%; High-intensity statin therapy recommended for those with a 10-year risk for ASCVD ≥7.5%. Diabetes includes diagnosed and undiagnosed. Diagnosed diabetes is defined for those who other than during pregnancy were told by a doctor or health professional that they had diabetes or sugar diabetes; taking insulin or taking diabetic pills to lower your blood sugar; Undiagnosed diabetes is defined as a fasting plasma glucose ≥126 mg/dL or an HbA1c ≥6.5%.
4. Aged 40-75 years without clinical ASCVD or diabetes with LDL-c 70-189 mg/dL, and estimated ASCVD risk ≥7.5%: Moderate- to High-intensity statin therapy recommended.

ASCVD risk score is calculated based on the equations published by ACC/AHA. (Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson J, Schwartz JS, Smith SC Jr, Sorlie P, Shero ST, Stone NJ, Wilson PW. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;129 [suppl 2]:S1-S45.))

Cholesterol treatment defined as self report of following health professional's advice to take prescribed medicine to lower cholesterol or statin use identified in the prescription medication file.