Statin adherence and LDL cholesterol levels. Should we assess adherence prior to statin upgrade?

Vodonos, Alina; Остапенко, І. А.; Toledano, Ronen; Henkin, Yaakov; Zahger, Doron; Wolak, Talya; Sherf, Michael; Novack, Victor

doi:10.1016/j.ejim.2015.02.014

Cited by 23 publications

(15 citation statements)

References 18 publications

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“…However, the rates of high‐intensity statin use reported in the current study were more closely aligned with those reported in recent European studies. In those studies, high‐intensity statin use ranged from 7.4% among unselected patients to 9.4% in high‐risk patients with controlled low‐density lipoprotein cholesterol (LDL‐C) levels …”

Section: Discussionmentioning

confidence: 99%

“…In those studies, highintensity statin use ranged from 7.4% among unselected patients to 9.4% in high-risk patients with controlled lowdensity lipoprotein cholesterol (LDL-C) levels. 18,19 The ACC/AHA blood cholesterol guidelines advocate for use of risk-appropriate statin dose and potency (as well as adjuvant LMY as indicated) to optimally reduce risk for cardiovascular events. 10 There is a clear continued need to encourage clinicians to treat patients at risk more aggressively and with higher doses of statins than is currently observed.…”

Section: Discussionmentioning

confidence: 99%

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Burden of First and Recurrent Cardiovascular Events Among Patients With Hyperlipidemia

Punekar

Fox

Richhariya

et al. 2015

Clinical Cardiology

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Background: Acute cardiovascular (CV) events have been evaluated in patients with specific comorbidities but have not focused on patients with hyperlipidemia or on the their long-term costs. Objectives: To evaluate incidence of CV events, costs, and resource utilization among patients with hyperlipidemia and baseline risk of CV disease (CVD). Methods: Patients (age 18 to 64 years) diagnosed with hyperlipidemia or using lipid-modifying medications were identified from administrative claims. Patients were categorized into 3 cohorts based on pre-index clinical characteristics-secondary prevention (SP; history of CV event, n = 15 613); high risk (HR; CVD, n = 47 600); and primary prevention (PP; no CV event history or CVD, n = 60 637)-and followed up to 2 years after the CV event.Results: During follow-up, ≥1 new CV event occurred in 43.0% of the SP cohort, 33.9% of HR, and 20.9% of PP; and ≥3 new events occurred in 19.8% of the SP cohort, 12.9% of HR, and 5.5% of PP. Incremental total costs were $19 320 for SP, $20 003 for HR, and $17 650 for PP. Compared with patients with only 1 CV event, the mean 2-year cost was 30% higher in patients with 2 CV events and 48% higher in patients with 3 CV events. Only 50% of HR patients (with or without CV events) received statins. Conclusions: Patients with recurrent CV events had higher total health care costs during 24-month follow-up for each type of CV event. Total health care costs among patients with a CV event were higher for the initial as well as subsequent events. Statins and lipid-modifying medications were significantly underutilized in all cohorts, despite the presence of CVD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Burden of First and Recurrent Cardiovascular Events Among Patients With Hyperlipidemia

Punekar

Fox

Richhariya

et al. 2015

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…By comparison, statin adherence rates in clinical trials were approximately 77 % in the active treatment arms [2••]. As expected, adherent patients (MPR >80 %) had significantly lower LDL compared to non-adherent patients (MPR <80 %) (LDL 100 vs. 116 mg/dL, p < 0.001) [18]. The association between patients with a MPR >80 % and LDL levels remained significant across moderate-and highintensity statin strata, and there was a non-significant trend (p = 0.060) in the low-intensity stratum.…”

Section: Revisiting the Risk/benefit Conversation With Nonadherencementioning

confidence: 80%

“…In order to determine the effects of adherence on the LDL lowering capabilities of different statins (low, moderate, and high intensity), Vodonos et al retrospectively analyzed cohort data from 1183 patients in an urban primary care setting [18]. Adherence was estimated using the medication possession ratio (MPR), with a MPR of <80 % defining nonadherence, a threshold that translates to approximately 6 missed doses (of a once daily medication) in a 30-day period.…”

Section: Revisiting the Risk/benefit Conversation With Nonadherencementioning

confidence: 99%

Current Use of Statins for Primary Prevention of Cardiovascular Disease: Patient-Reported Outcomes and Adherence

Coon

Ashjian

Herink

2016

Curr Cardiovasc Risk Rep

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Recent updates in atherosclerotic cardiovascular disease (ASCVD) risk assessment and management guidelines have expanded the global number of statin-indicated persons, prompting clinicians to rethink conversations about initiating new statin therapy. The benefits of statins in primary prevention of ASCVD are less convincing than in secondary prevention, although higher ASCVD risk is associated with greater statin benefit. Therefore, clinicians must engage patients in a shared decision about starting new statin therapy, which should involve discussion about the risks and benefits of therapy, patient perceptions, and health status. Research has identified nonadherence to statin therapy as a factor associated with reduced clinical benefits of statin therapy. Clinicians should be aware of patient-specific factors associated with nonadherence and implement strategies to improve adherence as indicated. Data on the impact of adherence improvement strategies and the accuracy of how we currently measure adherence are lacking. Additionally, research focusing on patient preferences and reported outcomes would greatly inform practice and improve clinician-patient relationships.

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“…Considering that statin adherence of patients is inversely correlated with the intensity of statins [8] and the “high intensity-like” effect of namely moderate intensity statins among Koreans, it is about time to resettle the evidence-based Korean dyslipidemia treatment guidelines for patients with diabetes.…”

mentioning

confidence: 99%

Letter: Efficacy of Moderate Intensity Statins in the Treatment of Dyslipidemia in Korean Patients with Type 2 Diabetes Mellitus (Diabetes Metab J 2017;41:23-30)

Jeon

2017

Diabetes Metab J

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Statin adherence and LDL cholesterol levels. Should we assess adherence prior to statin upgrade?

Cited by 23 publications

References 18 publications

Burden of First and Recurrent Cardiovascular Events Among Patients With Hyperlipidemia

Burden of First and Recurrent Cardiovascular Events Among Patients With Hyperlipidemia

Current Use of Statins for Primary Prevention of Cardiovascular Disease: Patient-Reported Outcomes and Adherence

Letter: Efficacy of Moderate Intensity Statins in the Treatment of Dyslipidemia in Korean Patients with Type 2 Diabetes Mellitus (Diabetes Metab J 2017;41:23-30)

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