Treatment Gap in Primary Prevention Patients Presenting With Acute Coronary Syndrome

Bavishi, Aakash; Howard, Travis; Kim, Jooho P; Hiramoto, Brent; Pierce, Jacob B.; Mendapara, Parrykumar; Alhalel, Jonathan; Wu, Han Wei; Srdanovich, Nina; Stone, Neil J.

doi:10.1016/j.amjcard.2018.10.034

Cited by 5 publications

(2 citation statements)

References 17 publications

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“…Since the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) blood cholesterol guidelines, there has been a shift from treating with a fixed LDL-C target to selecting appropriate intensity statin therapy based on individual atherosclerotic cardiovascular disease (ASCVD) risk. 5 Despite current guidelines in routine clinical practice, statin intolerance and other factors may lead to treatment discontinuation, switching among statin agents, dose adjustments, or the need for augmentation of the statin regimen impacting therapeutic benefits and patient outcomes. 6…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Statin Indication and Dose Intensification Among Type 2 Diabetic Patients at a Tertiary Hospital

Fisseha,

Baye,

Beyene

et al. 2024

DMSO

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Background Diabetes mellitus (DM) increases cardiovascular disease (CVD) incidence and mortality. While guidelines endorse statin use in type 2 DM (T2DM) to mitigate cardiovascular risks and mortality, challenges like statin initiation and prompt treatment adjustments affect patient outcomes. This study aimed to assess the appropriateness of indications for and dose intensification of statin therapy among T2DM patients at Tikur Anbessa Specialized Hospital (TASH). Methodology A hospital-based cross-sectional study was conducted from April 1 to June 30 2020. In total, 405 T2DM patients were selected using a systematic random sampling technique. The data were analyzed using SPSS version 26.0. An adjusted odds ratio (OR) was used and a 95% confidence interval (CI) and p-values of <0.05 were utilized to determine statistical significance. Results Of the total 405 participants, 346 (85.4%) started taking statins for primary or secondary prevention purposes. Indication for statin use was appropriate in 96.2% patients, while for 216 (62.4%) patients their doses were appropriately intensified. Predictors of the inappropriateness of statin use were an atherosclerotic cardiovascular disease (ASCVD) score of ≥7.5% (AOR=0.28; 95% CI: 0.102–0.738, p=0.01), the presence of dyslipidemia (AOR=4.48; 95% CI: 1.85–10.84; p=0.001), initiation of aspirin therapy (AOR=3.7; 95% CI: 1.522–9.144; p=0.004), and an LDL-cholesterol level of 70–189 mg/dL (AOR=0.124; 95% CI: 0.042–0.365; p=0.001). DM duration of ≥10 years (AOR=2.51; 95% CI: 1.35–4.66, p=0.004), male gender (AOR=2.04; 95% CI: 1.16–3.58, p=0.013), age ≥65 years (AOR=2.15; 95% CI: 1.23–3.75, p=0.007) and uncontrolled blood pressure (AOR=2.09; 95% CI: 1.07–4.08, p=0.031) were associated with inappropriate statin intensification. Conclusion The study found that indication of statins was optimal and about two-thirds of patients had their doses appropriately intensified. Monitoring is needed to avoid inappropriate intensification of statin therapy, particularly in patients with longer diabetes duration, those of male gender and advanced age, and those with uncontrolled blood pressure.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Statin Indication and Dose Intensification Among Type 2 Diabetic Patients at a Tertiary Hospital

Fisseha,

Baye,

Beyene

et al. 2024

DMSO

View full text Add to dashboard Cite

show abstract

“…Since the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) blood cholesterol guidelines, there has been a shift from treating with a xed LDL-C target to selecting appropriate intensity statin therapy based on individual Atherosclerotic Cardiovascular Disease (ASCVD) risk (5). Despite current guidelines in routine clinical practice, statin intolerance and other factors may lead to treatment discontinuation, switching among statin agents, dose adjustments, or the need for augmentation of the statin regimen impacting therapeutic bene ts and patient outcomes(6).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of statin indication and dose intensification among type 2 diabetic patients at Tikur Anbessa Specialized Hospital

Yitbarek,

Baye,

Gedamu

et al. 2023

Preprint

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Background Diabetes Mellitus (DM) increases the incidence and mortality of cardiovascular diseases (CVD) by a 2 to 4-fold compared to people without DM. Although clinical practice guidelines recommend the use of statin in type 2 DM (T2DM) patients to reduce cardiovascular risks and all-cause mortality, statin intolerance and other factors may lead to treatment discontinuation, switching among statin agents, dose adjustments, or the need for augmentation of the statin regimen impacting therapeutic benefits and patient outcomes. This study aimed to assess the appropriateness of indication and dose intensification of statin therapy among T2DM patients at Tikur Anbessa Specialized Hospital (TASH). Methodology : A hospital-based cross-sectional study design was conducted among 405 T2DM patients from 01 April to 30 June 2020. A systematic random sampling technique was implemented to recruit study participants who had been on follow-up during the study period in TASH. Adjusted odds ratio (OR) was used to measure the association of dependent and independent variables at 95% confidence interval (CI) and P-values of < 0.05 were utilized to determine the statistical significance. Results Statins were initiated for 85.4% of patients. Majority (82.9%) of patients were indicated statin for primary prevention and the estimated 10-year ASCVD scores were ≥ 7.5% among 60.1% of patients. Among 346 patients on statin therapy, the indication was appropriate in 333 (96.2%) patients while 216 (62.4%) patients were appropriately intensified. Predictors for appropriateness of statin indication were ASCVD score ≥ 7.5% (AOR = 0.275; 95% CI: 0.102–0.738, p = 0.01), presence of dyslipidemia (AOR = 4.48; 95%CI: 1.85–10.84; p = 0.001), initiation of aspirin therapy (AOR = 3.7; 95%CI: 1.522–9.144; p = 0.004), and LDL-cholesterol level 70–189 mg/dL (AOR = 0.124; 95% CI:0.042–0.365; p = 0.001). Moreover, duration of illness (AOR = 3.22, 95% CI: 1.680-6.1351, P < 0.001) and history of vascular complications (AOR = 3.24, 95% CI: 1.085,9.708, P = 0.035) were associated with inappropriate dose intensification of statins. Conclusion The study found that indication of statins was generally in line with guidelines, but inappropriate statin dose intensification was linked to patients with longer duration of diabetes and vascular complications. Clinicians should consider dose titration of statins based on patient cardiovascular risk profile and routine laboratory results.

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Cost-Effectiveness of Coronary Artery Calcium Scoring in People With a Family History of Coronary Disease

Venkataraman

Kawakami

Huynh

et al. 2021

JACC: Cardiovascular Imaging

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Treatment Gap in Primary Prevention Patients Presenting With Acute Coronary Syndrome

Cited by 5 publications

References 17 publications

Evaluation of Statin Indication and Dose Intensification Among Type 2 Diabetic Patients at a Tertiary Hospital

Evaluation of Statin Indication and Dose Intensification Among Type 2 Diabetic Patients at a Tertiary Hospital

Evaluation of statin indication and dose intensification among type 2 diabetic patients at Tikur Anbessa Specialized Hospital

Cost-Effectiveness of Coronary Artery Calcium Scoring in People With a Family History of Coronary Disease

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