Therapeutic inertia in hypercholesterolaemia is associated with ischaemic events in primary care patients. A case-control study

Rodríguez, Ángel Díaz; Murga, Nekane; Babkowski, Miguel Camafort; Peral, J. C. López; Ruiz, Emilio Muñoz; Ruiz-Baena, Jessica; Valdivielso, Pedro

doi:10.1111/ijcp.12419

Cited by 8 publications

(5 citation statements)

References 34 publications

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“…En el caso de los centros hospitalarios, la mayoría estaban organizados en Servicios o Unidades (el 74,48%), con una media de 12,83 (11,(8)(9)(10)(11)(12)(13),87) cardiólogos de plantilla y 4,76 (4,08-5,43) médicos internos residentes en cardiología por Servicio. En la tabla 1 se muestra la distribución de participantes por comunidades autónomas.…”

Section: Resultados Descripción De La Muestra De Médicos Participantesunclassified

Atención al alta en pacientes con síndrome coronario agudo y control de la dislipidemia en la práctica clínica en España: Estudio SINCOPA

Murga

Ruiz

Pascual³

2015

Clínica e Investigación en Arteriosclerosis

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Section: Resultados Descripción De La Muestra De Médicos Participantesunclassified

Atención al alta en pacientes con síndrome coronario agudo y control de la dislipidemia en la práctica clínica en España: Estudio SINCOPA

Murga

Ruiz

Pascual³

2015

Clínica e Investigación en Arteriosclerosis

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“…Unfortunately, the under treatment of hypercholesterolemia in Europe (generally) and France (specifically) has been demonstrated in multiple previous studies [ 8 , 10–12 , 26–30 ]. The Europe-wide DA VINCI study of primary or secondary prevention patients being treated in primary care or by a cardiologist found that only 33% of patients achieved the 2019 guideline recommended LDL-C targets [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, only 18% of patients in the very high-risk category achieved the 2019 LDL-C targets in the DA VINCI study; only 11% reached this target on statin monotherapy and 21% achieved the target on the combination of a statin with ezetimibe or PCSK9 inhibitor [ 29 ]. This is concerning because data show that therapeutic inertia in the management of hypercholesterolemia is associated with an increased risk of CV events [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of hypercholesterolemia management in at-risk patients by cardiologists in France: a case vignette-based study

Ferrières

Bruckert

Farnier³

et al. 2023

J. Comp. Eff. Res.

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Aim: This online interactive survey investigated lipid-lowering approaches of French cardiologists in high- and very high-cardiovascular risk patients with hypercholesterolemia. Materials & methods: Physicians assessed three hypothetical patients at three clinic visits, and selected the patients’ cardiovascular risk category, target low-density lipoprotein cholesterol (LDL-C) and treatment. Results: A total of 162 physicians completed 480 risk assessments; 58% of assessments correctly categorized the hypothetical patients. Most physicians chose the correct LDL-C target for one of the very high-risk patients, but higher-than-recommended targets were selected for the other very high-risk patient and the high-risk patient. Statins were the most commonly chosen treatment. Conclusion: French cardiologists often underestimate cardiovascular risk in patients with hypercholesterolemia, select a higher-than-recommended LDL-C target and prescribe less intensive treatment than that recommended by guidelines.

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“…Therapeutic inertia has been shown to correlate with negative outcomes. In a case-controlled multivariate analysis of data from high-risk patients with hypercholesterolemia who had experienced an ischemic event (N = 470), therapeutic inertia at baseline was significantly associated with short-term recurrence of ischemic events (OR 2.18 [95% CI 1.04-4.51], p < 0.05) [43]. Moreover, in a retrospective database study of patients who had a cardiovascular event between 2004 and 2016 (N = 28,625), less than 25% of patients had experienced lipid control and only 22% of patients were taking a high-intensity statin 6 months after the index event [15].…”

Section: Therapeutic Inertiamentioning

confidence: 99%

Is it Time for Single-Pill Combinations in Dyslipidemia?

Schiele

Isla

Arca

et al. 2021

Am J Cardiovasc Drugs

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Despite the availability of lipid-lowering therapies (LLTs) that are safe and effective, the overall rate of low-density lipoprotein cholesterol (LDL-C) control at a population level in real-life studies is low. Higher-intensity treatment, earlier intervention, and longer-term treatment have all been shown to improve outcomes. However, in clinical practice, actual exposure to LLT is a product of the duration and intensity of, and adherence to, the treatment. To increase exposure to LLTs, the European Society of Cardiology guidelines recommended a stepwise optimization of LLTs by increasing statin intensity to the maximally tolerated dose, with subsequent addition of ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Evidence from randomized controlled trials performed in a range of patients suggested that adding ezetimibe to statins rather than doubling the statin dose resulted in significantly more patients at LDL-C goal and significantly fewer patients discontinuing treatment because of adverse events. In addition, data showed that combination treatments effectively increased exposure to LLT. Despite these data and recommendations, optimization of LLT is often limited to increasing statin dose. Therapeutic inertia and poor treatment adherence are significant and prevalent barriers to increasing treatment exposure. They are known to be influenced by pill burden and complexity of treatment. Single-pill combinations provide a strategic approach that supports the intensification of treatment without increasing pill burden or treatment complexity. Single-pill combinations, compared with free associations, have been shown to increase the adherence to LLT and the percentage of patients at LDL-C goal.

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Therapeutic inertia in hypercholesterolaemia is associated with ischaemic events in primary care patients. A case-control study

Abstract: The TI in high-risk hypercholesterolaemic patients in primary prevention in Spanish primary care centres doubled the risk of an ischaemic event in the short term.

Cited by 8 publications

References 34 publications

Atención al alta en pacientes con síndrome coronario agudo y control de la dislipidemia en la práctica clínica en España: Estudio SINCOPA

Atención al alta en pacientes con síndrome coronario agudo y control de la dislipidemia en la práctica clínica en España: Estudio SINCOPA

Evaluation of hypercholesterolemia management in at-risk patients by cardiologists in France: a case vignette-based study

Is it Time for Single-Pill Combinations in Dyslipidemia?

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