Switching from high-efficacy lipid-lowering therapies to simvastatin and low-density lipoprotein cholesterol goal attainment in coronary heart disease/coronary heart disease-equivalent patients

Changes in prescription patterns before and after reporting of the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression trial (ENHANCE) results and expected effects on low-density lipoprotein-cholesterol reduction

“…Overall, these results are consistent with other studies that show reduced LDL-C lowering when patients are switched from high-potency, lipid-lowering therapy to less efficacious doses. [32][33][34] The role of LDL-C lowering as a surrogate of cardiovascular risk was also brought into question after the ENHANCE trial, despite the large body of data demonstrating that the degree of LDL-C lowering is associated with cardiovascular event reduction, 35,36 regardless of the means by which it is achieved. [37][38][39][40] In addition, such scientific controversies played out in the public domain can impact the conduct of other clinical trials and public health.…”

Achievement of specified low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol apolipoprotein B, and high-sensitivity C-reactive protein levels with ezetimibe/simvastatin or atorvastatin in metabolic syndrome patients with and without atherosclerotic vascular disease (from the VYMET study)

“…Similar observations have been made when comparing the treatment effects of ezetimibe/simvastatin with atorvastatin and rosuvastatin, with larger treatment differences in favor of ezetimibe/simvastatin found in subjects with AVD compared with those without. 19 This trial was designed to assess the recommended starting and next higher doses of both ezetimibe/simvastatin (10/20 mg and 10/40 mg) and atorvastatin (10,20, and 40 mg) because these are the doses most commonly used in clinical practice. 20 Previous studies have demonstrated a differential effect of treatment on the percent reduction in LDL-C, non-HDL-C, and Apo B.…”

“…19 This trial was designed to assess the recommended starting and next higher doses of both ezetimibe/simvastatin (10/20 mg and 10/40 mg) and atorvastatin (10,20, and 40 mg) because these are the doses most commonly used in clinical practice. 20 Previous studies have demonstrated a differential effect of treatment on the percent reduction in LDL-C, non-HDL-C, and Apo B. Data from the Measuring Effective Reductions in Cholesterol Using Rosuvastatin II trial demonstrated that after 16 weeks of therapy with rosuvastatin (10 or 20 mg), atorvastatin (10 or 20 mg), or simvastatin (20 or 40 mg), LDL-C and non-HDL-C were reduced to a greater extent than Apo B, which suggested that attainment of recommended Apo B levels may require reaching LDL-C levels well below current targets.…”

Predictors of Statin Compliance after Switching from Branded to Generic Agents among Managed-Care Beneficiaries

“…12,13 Patients with coronary heart disease (CHD) or CHD-risk equivalents were identified by ICD-9 CM and Current Procedural Terminology codes. 14 We identified statin prescription fills and copayments in the pharmacy claims database. Branded and generic statins were differentiated by a generic indicator flag associated with each claim.…”