{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T02:39:11Z","timestamp":1790995151889,"version":"4.1.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,4,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Few adults at high risk for atherosclerotic cardiovascular disease events use a PCSK9i (proprotein convertase subtilisin\/kexin type 9 inhibitor).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Using data from the US Veterans Health Administration, we identified veterans who initiated a PCSK9i between January 2018 and December 2019, matched 1:4 to veterans who did not initiate this medication over this time period (case\u2010cohort study). Two cohorts of veterans were analyzed: (1) atherosclerotic cardiovascular disease, with a most recent low\u2010density lipoprotein cholesterol (LDL\u2010C) \u226570\u00a0mg\/dL; and (2) severe hypercholesterolemia (ie, familial hypercholesterolemia or any prior LDL\u2010C \u2265190\u00a0mg\/dL, with most recent LDL\u2010C \u2265100\u00a0mg\/dL). Conditional logistic regression was used to analyze factors associated with PCSK9i initiation, adjusting for all factors, simultaneously. There were 2394 initiators and 9576 noninitiators in the atherosclerotic cardiovascular disease cohort (median LDL\u2010C, 141 and 96\u00a0mg\/dL, respectively;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Factors associated with a higher likelihood of PCSK9i initiation included age 65 to &lt;75 versus &lt;65\u00a0years, highest versus lowest quartile of median area\u2010level income, familial hypercholesterolemia, former statin use, and current ezetimibe use. PCSK9i initiation was lower among veterans of a race\/ethnicity other than non\u2010Hispanic White. There were 245 initiators and 980 noninitiators in the severe hypercholesterolemia cohort (median LDL\u2010C, 183 and 151\u00a0mg\/dL, respectively;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Age \u226575 versus &lt;65\u00a0years, history of chronic kidney disease, former statin use, and current ezetimibe use were associated with a higher likelihood of PCSK9i initiation.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Several patient\u2010level factors, including age, sex, and race\/ethnicity, were significantly associated with PCSK9i initiation, suggesting an unmet treatment need in several patient groups.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.019254","type":"journal-article","created":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T09:54:27Z","timestamp":1617702867000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Factors Associated With PCSK9 Inhibitor Initiation Among US Veterans"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7382-4607","authenticated-orcid":false,"given":"Catherine G.","family":"Derington","sequence":"first","affiliation":[{"name":"Division of Health System Innovation and Research Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8742-1788","authenticated-orcid":false,"given":"Lisandro D.","family":"Colantonio","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Alabama at Birmingham School of Public Health Birmingham AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9257-8843","authenticated-orcid":false,"given":"Jennifer S.","family":"Herrick","sequence":"additional","affiliation":[{"name":"Division of Epidemiology Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"},{"name":"Informatics, Decision\u2010Enhancement and Analytic Sciences Center of Innovation Veterans Affairs Salt Lake City Health Care System Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5242-3975","authenticated-orcid":false,"given":"James","family":"Cook","sequence":"additional","affiliation":[{"name":"Division of Epidemiology Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"},{"name":"Informatics, Decision\u2010Enhancement and Analytic Sciences Center of Innovation Veterans Affairs Salt Lake City Health Care System Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6783-7951","authenticated-orcid":false,"given":"Jordan B.","family":"King","sequence":"additional","affiliation":[{"name":"Division of Health System Innovation and Research Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT"},{"name":"Institute for Health Research Kaiser Permanente Colorado Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5599-0633","authenticated-orcid":false,"given":"Robert S.","family":"Rosenson","sequence":"additional","affiliation":[{"name":"Mount Sinai Heart Icahn School of Medicine at Mount Sinai New York NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-2561","authenticated-orcid":false,"given":"Bharat","family":"Poudel","sequence":"additional","affiliation":[{"name":"Department of Epidemiology University of Alabama at Birmingham School of Public Health Birmingham AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keri L.","family":"Monda","sequence":"additional","affiliation":[{"name":"Center for Observational Research and Medical Affairs Amgen Inc Thousand Oaks 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