A study led by Johns Hopkins researchers reveals a striking gap between the number of patients who should be taking cholesterol-lowering drugs like statins and those who actually do.
Despite the proven safety and effectiveness of statins and other lipid-lowering medications, coronary artery disease remains a leading cause of death worldwide. Many adults eligible for treatment to reduce their low-density lipoprotein (LDL) cholesterol levels are not receiving it, prompting the researchers to quantify this treatment gap.
Analysing data from nearly 5,000 U.S. adults, the team found that among individuals without a history of major cardiovascular events, 47% were eligible for cholesterol-lowering therapy under current U.S. guidelines, yet only 23% were receiving treatment. Among those with a prior major cardiovascular event, while 100% were eligible, only 68% were on therapy.
Closing this treatment gap could prevent nearly 100,000 non-fatal heart attacks and up to 65,000 strokes each year in the U.S., while also avoiding tens of thousands of bypass surgeries and stent placements annually. Aligning treatment with guideline recommendations could save up to $30.6 billion in medical costs related to preventable cardiovascular events each year, the researchers estimate.
These results add to the growing evidence that gaps in care for common, costly conditions like high cholesterol have significant consequences, and addressing them could yield substantial public health benefits.
The study examined nationally representative data from 4,980 U.S. adults aged 40–75, collected from 2013 to 2020 through the National Health and Nutrition Examination Surveys. Researchers assessed LDL cholesterol levels and cardiovascular risk profiles to determine eligibility for lipid-lowering therapy under 2018 U.S. guidelines, as well as actual medication use.
Applying European guidelines, which have stricter LDL targets, revealed even larger treatment gaps.
Among adults without prior cardiovascular events—a group representing approximately 116 million Americans—only 23% were receiving lipid-lowering therapy, despite 47% being eligible under U.S. guidelines. Among the 15 million Americans with a history of major cardiovascular events, only 68% were receiving treatment, although all were eligible under both U.S. and European guidelines.
The researchers estimate that aligning treatment for all eligible patients with guidelines, including the use of non-statin LDL-lowering medications where appropriate, could reduce median LDL cholesterol levels significantly and lower the risk of major cardiovascular events in the U.S. by up to 27%.
The researchers highlight several factors contributing to these treatment gaps. These include variations in clinician training, patient preferences, barriers to accessing care, financial incentives that don’t always support best practices, and the challenges of implementing guidelines in busy clinical settings.
Improving alignment with treatment guidelines could involve better screening, expanding patient education on the benefits of therapy, and addressing structural barriers to care.
High cholesterol is a silent but critical public health issue, with millions unaware they have it, and even among those who know, treatment often falls short. Evidence-based action is crucial to close this gap and prevent devastating cardiovascular events.
Source: Johns Hopkins Bloomberg School of Public Health
Image Credit: iStock
References:
Alexander GC, Curran J, Victores A et al. (2025) US Public Health Gains from Improved Treatment of Hypercholesterolemia: A Simulation Study of NHANES Adults Treated to Guideline-Directed Therapy. Journal of General Internal Medicine.
