Timing of statin initiation for primary atherosclerotic cardiovascular disease (ASCVD) prevention following lung cancer screening in Missouri: A retrospective cohort study.

Abstract

e22537 Background: Individuals undergoing lung cancer screening (LCS) represent a population at elevated risk for Atherosclerotic Cardiovascular Disease (ASCVD) due to overlapping risk factors like smoking. Although statin therapy is recommended for many individuals undergoing LCS, little is known about the timing of statin initiation in relation to LCS, particularly among statin-naïve individuals. We examined time to statin initiation following LCS and factors associated with earlier prescribing. Methods: We conducted a retrospective cohort study using electronic health record data from Barnes Jewish healthcare system in Missouri. Adults aged 50–80 years who underwent LCS between 2022–2023, were statin-naïve, and met 2019 ACC/AHA criteria for primary prevention were included. The primary outcome was time from LCS to statin initiation. Kaplan–Meier methods described statin uptake over time, and multivariable Cox proportional hazards models estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for predictors of statin initiation. Results: Among 3,223 statin-eligible individuals (mean age 64.9±6.4 years; 48.7% female; 24.4% Black), only 33.6% (n = 1,082) were prescribed a statin within one year following LCS. Cumulative statin initiation remained low over time, with 2.9% by 90 days, 5.7% by 180 days, and 11.2% by 360 days post-LCS. Median time to statin initiation was not reached due to high censoring (66.4%). In adjusted analyses, earlier statin initiation was associated with diabetes (HR 1.36, 95% CI 1.18–1.57), hypertension (HR 1.44, 95% CI 1.24–1.67), chronic kidney disease (HR 1.21, 95% CI 1.01–1.44), and a cardiology visit in the year preceding LCS (HR 1.25, 95% CI 1.07–1.45). Former smokers were more likely to initiate statins than current smokers (HR 1.16, 95% CI 1.01–1.34). Increasing age was modestly associated with lower likelihood of initiation (HR per year 0.98, 95% CI 0.97–0.99). ASCVD risk category was not independently associated with time to statin initiation when compared with low risk (high risk HR 1.45, 95% CI 0.84–2.50). Race, sex, insurance type, and area deprivation index were not significantly associated with statin initiation. Conclusions: Among statin-eligible patients with no prior statin use before lung cancer screening, statin initiation was uncommon and substantially delayed. Prescribing was driven by comorbid conditions and specialty care rather than calculated ASCVD risk. Integrating cardiovascular risk assessment and preventive decision support into LCS workflows may reduce missed opportunities for ASCVD prevention in this high-risk population.