Patterns of statin use and cholesterol goal attainment in a high-risk cardiovascular population: A retrospective study of primary care electronic medical records

García-Gil, Maria; Blanch, Jordi; Comas-Cufí, Marc; Daunis‐i‐Estadella, Pepus; Bolíbar, Bonaventura; Martí, Ruth; Ponjoan, Anna; Alves-Cabratosa, Lia; Ramos, Rafael

doi:10.1016/j.jacl.2015.10.007

Cited by 33 publications

(24 citation statements)

References 46 publications

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“…26 The fact of poor awareness/management of FH might be explained by variables. [27][28][29] Of them, hospitals or cardiologists can play a significant role because they are likely to be the first to encounter the patients and their families, but the clinical care is not well developed and provided in China to date. Patients' knowledge and compliance are also reasons for great concern.…”

Section: Discussionmentioning

confidence: 99%

Familial Hypercholesterolemia Phenotype in Chinese Patients Undergoing Coronary Angiography

Zhu

et al. 2017

ATVB

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Large-scale clinical studies of FH have been reported from many countries, 2,7-16 but the features of FH in China are largely unknown. 17 Furthermore, the actual prevalence of FH is likely to be underestimated in the past, and the FH trait is masked by the CAD phenotype or more common risk factors without the genetically elevated cholesterol levels.3 Hence, the aim of present study was to investigate patients with FH phenotype and further provide molecular data on mutations for patients with FH in the Division of Dyslipidemia of Fu Wai Hospital, the only national center of dyslipidemia in China.© 2016 American Heart Association, Inc. Objective-Familial hypercholesterolemia (FH) is characterized by an elevated low-density lipoprotein cholesterol and increased risk of premature coronary artery disease. However, the general picture and mutational spectrum of FH in China are far from recognized, representing a missed opportunity for the investigation. Approach and Results-A total of 8050 patients undergoing coronary angiography were enrolled. The diagnosis of clinical FH was made using Dutch Lipid Clinic Network criteria, and the information of relatives was obtained by inquiring for the probands or from their own medical records of certain clinics/hospitals. Molecular analysis of FH was performed using target exome sequencing in LDLR (low-density lipoprotein cholesterol receptor gene), APOB (apolipoprotein B gene), and PCSK9 (proprotein convertase subtilisin/kexin type 9 gene). As a result, 3.5% of the patients with definite/ probable FH phenotype (definite 1.0% and probable 2.5%) were identified. Women FH had fewer premature coronary artery disease (women <60, or men <55 years of age) when compared with men FH (70.6% versus 82.7%; P<0.001), whereas angiographic extension of coronary artery disease was significantly increased with FH diagnosis in both men and women (P<0.001). Patterns of medication use in definite/probable FH were as follows: nontreated, 20.6%; low intensity, 6.0%; moderate intensity, 68.3%; and high intensity, 5.0%. However, none of them had achieved the lowdensity lipoprotein cholesterol <100 mg/dL. Additionally, mutational analysis was performed in 245 definite/probable FH cases, and risk variants were identified in 115 patients, giving a detection rate of 46.9%. Conclusions-We showed firsthand a common identification but poor treatment of patients with FH phenotype in Chinese coronary angiography patients. Genetic data in our FH cases might contribute to update the frequency and spectrum of Chinese FH scenarios. Materials and MethodsMaterials and Methods are available in the online-only Data Supplement. Results Prevalence of FHBasic characteristics of the study population are summarized in Table 1. The mean (±SD) age of the participants was 57.2±10.5 years, of whom 68.7% were men and 83.8% were with CAD and 37.8% with pCAD (<55 years for men and <60 years for women). The mean total cholesterol and LDL-C were 165.25±50.58 and 101.54±43.63 mg/dL, respectively. In the sample, there were 1.0% def...

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Section: Discussionmentioning

confidence: 99%

Familial Hypercholesterolemia Phenotype in Chinese Patients Undergoing Coronary Angiography

Zhu

et al. 2017

ATVB

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“…The high quality of SIDIAP Q data has been previously validated and the database has been widely used to study the epidemiology of several health outcomes 242526. Confidentiality in the SIDIAP Q database is rigorously assured by a standardised system of codification that involves all possible identifier variables, which are not available to investigators.…”

Section: Introductionmentioning

confidence: 99%

Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study

Ramos

Comas-Cufí

Martí-Lluch

et al. 2018

BMJ

Self Cite

148

107

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ObjectiveTo assess whether statin treatment is associated with a reduction in atherosclerotic cardiovascular disease (CVD) and mortality in old and very old adults with and without diabetes.DesignRetrospective cohort study.SettingDatabase of the Catalan primary care system (SIDIAP), Spain, 2006-15.Participants46 864 people aged 75 years or more without clinically recognised atherosclerotic CVD. Participants were stratified by presence of type 2 diabetes mellitus and as statin non-users or new users.Main outcome measuresIncidences of atherosclerotic CVD and all cause mortality compared using Cox proportional hazards modelling, adjusted by the propensity score of statin treatment. The relation of age with the effect of statins was assessed using both a categorical approach, stratifying the analysis by old (75-84 years) and very old (≥85 years) age groups, and a continuous analysis, using an additive Cox proportional hazard model.ResultsThe cohort included 46 864 participants (mean age 77 years; 63% women; median follow-up 5.6 years). In participants without diabetes, the hazard ratios for statin use in 75-84 year olds were 0.94 (95% confidence interval 0.86 to 1.04) for atherosclerotic CVD and 0.98 (0.91 to 1.05) for all cause mortality, and in those aged 85 and older were 0.93 (0.82 to 1.06) and 0.97 (0.90 to 1.05), respectively. In participants with diabetes, the hazard ratio of statin use in 75-84 year olds was 0.76 (0.65 to 0.89) for atherosclerotic CVD and 0.84 (0.75 to 0.94) for all cause mortality, and in those aged 85 and older were 0.82 (0.53 to 1.26) and 1.05 (0.86 to 1.28), respectively. Similarly, effect analysis of age in a continuous scale, using splines, corroborated the lack of beneficial statins effect for atherosclerotic CVD and all cause mortality in participants without diabetes older than 74 years. In participants with diabetes, statins showed a protective effect against atherosclerotic CVD and all cause mortality; this effect was substantially reduced beyond the age of 85 years and disappeared in nonagenarians.ConclusionsIn participants older than 74 years without type 2 diabetes, statin treatment was not associated with a reduction in atherosclerotic CVD or in all cause mortality, even when the incidence of atherosclerotic CVD was statistically significantly higher than the risk thresholds proposed for statin use. In the presence of diabetes, statin use was statistically significantly associated with reductions in the incidence of atherosclerotic CVD and in all cause mortality. This effect decreased after age 85 years and disappeared in nonagenarians.

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“…Statins, by reducing blood cholesterol levels, decrease cardiovascular (CV) events and all-cause mortality in individuals with and without evidence of CV disease. 1 While rates of statin use are high in most European populations, 2 cholesterol control in these same populations is generally poor, 3,4 indicating that statin effectiveness may not correspond exclusively to the efficacy demonstrated in clinical trials, but rather is affected by real-life patterns of statin use. Among the contextual characteristics and behaviors that influence goal attainment, a key factor is ''patient persistence'' (i.e., whether the patient persists with treatment).…”

Section: Introductionmentioning

confidence: 99%

Persistence With Statins in Primary Prevention of Cardiovascular Disease: Findings From a Cohort of Spanish Workers

Malo

Aguilar-Palacio

Feja

et al. 2018

Revista Española de Cardiología (English Edition)

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Patterns of statin use and cholesterol goal attainment in a high-risk cardiovascular population: A retrospective study of primary care electronic medical records

Cited by 33 publications

References 46 publications

Familial Hypercholesterolemia Phenotype in Chinese Patients Undergoing Coronary Angiography

Familial Hypercholesterolemia Phenotype in Chinese Patients Undergoing Coronary Angiography

Statins for primary prevention of cardiovascular events and mortality in old and very old adults with and without type 2 diabetes: retrospective cohort study

Persistence With Statins in Primary Prevention of Cardiovascular Disease: Findings From a Cohort of Spanish Workers

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