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Pate A, Elliott RA, Gkountouras G, Thompson A, Emsley R, van Staa T. The impact of statin discontinuation and restarting rates on the optimal time to initiate statins and on the number of cardiovascular events prevented. Pharmacoepidemiol Drug Saf 2020; 29:644-652. [PMID: 32394495 DOI: 10.1002/pds.5023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/20/2020] [Accepted: 04/18/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION A patient is eligible for statins in England if they have a 10-year risk of cardiovascular disease >10%. We hypothesize that if statin discontinuation rates are high it may be better to delay statin initiation until patients are at a higher risk, to maximize the benefit of the drug. METHODS A four-state health state transition model was used to assess the optimal time to initiate statins after a risk assessment, in order to prevent the highest number of cardiovascular events, for a given risk profile (age, gender, risk) and adherence rate. A Clinical Practice Research Datalink dataset linked to Hospital Episodes Statistics and Office for National Statistics was used to inform the transition probabilities in this model, taking into account observed statin discontinuation and re-continuation patterns. RESULTS Our results suggest, if statins are initiated in a cohort of 50-year old men with a 10% 10-year risk, we prevent 4.78 events per 100 individuals. If we wait 10 years to prescribe, at which point 10-year risk scores are at 20%, we prevent 5.45 events per 100 individuals. If the observed discontinuation rate was reduced by a sixth, third or half in the same cohort, we would prevent 7.29, 9.01 or 10.22 events per 100 individuals. CONCLUSIONS In certain scenarios, extra cardiovascular disease events could be prevented by delaying statin initiation beyond a risk of 10% until reaching a age (59 for men, 63 for women), based on statin discontinuation rates in England. The optimal time to initiate statins was driven by age, not by cardiovascular risk.
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Affiliation(s)
- Alexander Pate
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rachel A Elliott
- Manchester Centre for Health Economics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Georgios Gkountouras
- Manchester Centre for Health Economics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alexander Thompson
- Manchester Centre for Health Economics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tjeerd van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Mohammadian Haftcheshmeh S, Karimzadeh MR, Azhdari S, Vahedi P, Abdollahi E, Momtazi-Borojeni AA. Modulatory effects of curcumin on the atherogenic activities of inflammatory monocytes: Evidence from in vitro and animal models of human atherosclerosis. Biofactors 2020; 46:341-355. [PMID: 31875344 DOI: 10.1002/biof.1603] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/11/2019] [Indexed: 12/14/2022]
Abstract
Atherosclerosis is a complex and long-lasting disorder characterized by chronic inflammation of arteries that leads to the initiation and progression of lipid-rich plaques, in which monocytes/macrophages play the central role in endothelial inflammation and taking up these lipids. Circulating monocytes can adopt a long-term proinflammatory phenotype leading to their atherogenic activities. During atherogenic condition, inflammatory monocytes adhere to the surface of the activated endothelial cells and then transmigrate across the endothelial monolayer into the intima, where they proliferate and differentiate into macrophages and take up the lipoproteins, forming foam cells that derive atherosclerosis progression. Therefore, modulating the atherogenic activities of inflammatory monocytes can provide a valuable therapeutic approach for atherosclerosis prevention and treatment. Curcumin is a naturally occurring polyphenolic compound with numerous pharmacological activities and shows protective effects against atherosclerosis; however, underlying mechanisms are not clearly known yet. In the present review, on the basis of a growing body of evidence, we show that curcumin can exert antiatherosclerotic effect through inhibiting the atherogenic properties of monocytes, including inflammatory cytokine production, adhesion, and transendothelial migration, as well as intracellular cholesterol accumulation.
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Affiliation(s)
| | - Mohammad R Karimzadeh
- Department of Medical Genetics, School of Medicine, Bam University of Medical Sciences, Bam, Iran
| | - Sara Azhdari
- Department of Anatomy and Embryology, School of Medicine, Bam University of Medical Sciences, Bam, Iran
| | - Parviz Vahedi
- Department of Anatomical Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Elham Abdollahi
- Department of Medical Immunology and Allergy, Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir A Momtazi-Borojeni
- Halal Research Center of IRI, FDA, Tehran, Iran
- Nanotechnology Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Rymer JA, Mues KE, Monda KL, Bratton EW, Wirtz HS, Okerson T, Overman RA, Brookhart MA, Muntner P, Wang TY. Use of Low-Density Lipoprotein-Lowering Therapies Before and After PCSK9 Inhibitor Initiation. J Am Heart Assoc 2020; 9:e014347. [PMID: 32326795 PMCID: PMC7428552 DOI: 10.1161/jaha.119.014347] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are used to reduce low-density lipoprotein (LDL) cholesterol. PCSK9i use after initiation, as well as persistence with or alterations to other LDL-lowering therapy after PCSK9i initiation, is not well understood. Methods and Results We conducted a retrospective study of alirocumab or evolocumab (PCSK9i) new users from July 2015 to December 2017 in the MarketScan Early View database of US commercial insurance beneficiaries. We determined the prevalence of PCSK9i interruption (≥30-day gap in supply) and LDL-lowering therapy use in the year after PCSK9i initiation. The average age of 6151 patients initiating PCSK9i therapy was 63 years, 44.4% were women, and 76.8% had atherosclerotic cardiovascular disease. Overall, 52.2% (95% CI, 50.8%-53.7%) of patients had an interruption in PCSK9i therapy in the first year after treatment initiation and 62.5% remained on PCSK9i therapy at 1-year postinitiation. Also, 27.7% of patients were taking a statin at the time of PCSK9i initiation, with only 22.4% on statin therapy at 1 year after PCSK9i initiation. Ezetimibe use decreased from 20.9% at the time of PCSK9i initiation to 12.0% a year later. By 1 year after PCSK9i initiation, 44.0% of patients had experienced an interruption in all LDL-lowering therapies, and 26.6% were no longer on any LDL-lowering therapies. Conclusions After PCSK9i initiation, statins were often discontinued, whereas more than half of patients experienced an interruption in PCSK9i therapy. These results suggest that many new PCSK9i users may remain at high risk for cardiovascular events because of interruptions in LDL-lowering therapy.
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Affiliation(s)
| | | | - Keri L Monda
- Center for Observational Research Amgen Inc Thousand Oaks CA
| | | | - Heidi S Wirtz
- Center for Observational Research Amgen Inc Thousand Oaks CA
| | - Ted Okerson
- Center for Observational Research Amgen Inc Thousand Oaks CA
| | | | - M Alan Brookhart
- NoviSci, Inc Durham NC.,University of North Carolina at Chapel Hill Chapel Hill NC
| | - Paul Muntner
- Department of Epidemiology University of Alabama at Birmingham AL
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Spann N, Hamper J, Griffith R, Cleveland K, Flynn T, Jindrich K. Independent pharmacist prescribing of statins for patients with type 2 diabetes: An analysis of enhanced pharmacist prescriptive authority in Idaho. J Am Pharm Assoc (2003) 2020; 60:S108-S114.e1. [PMID: 32127253 DOI: 10.1016/j.japh.2019.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study describes the development and patients' perceptions of a community pharmacist-led, statin-prescribing service for patients with diabetes and aims to identify why patients indicated for statin therapy were not prescribed therapy at the time of pharmacist consultation. SETTING This pilot service began in 4 community-based Albertsons Companies pharmacies located in western Idaho. Patients eligible for the statin-prescribing service had a current diagnosis of type 2 diabetes, were aged between 40 and 75 years, were currently taking medications to manage their diabetes and had no contraindications to statin therapy. PRACTICE DESCRIPTION Due to recent law changes in Idaho, pharmacists can now prescribe statins and certain other medications without oversight from a medical provider or the need for a collaborative practice agreement. PRACTIVE INNOVATION Patients were identified and contacted by their local community pharmacist to discuss the statin-prescribing service. Once statin therapy was initiated, patients completed a brief, 7-question survey regarding their perceptions of the service. EVALUATION This study evaluated the following: number of patients eligible for the prescribing service, number of patients who received a pharmacist-written statin prescription, and patients' perceptions regarding the service. METHODS Of the 64 patients screened, 18 (28%) were eligible for statin therapy. Of those eligible, 6 (33%) accepted pharmacist services and 4 patients started statin treatment. Two patients were prescribed a statin by the community pharmacist, whereas the other 2 patients contacted their primary care provider and requested a statin prescription at the pharmacist's recommendation. RESULTS Overall, participating patients (n = 4) reported feeling comfortable and satisfied with all aspects of the protocol and their pharmacist's role as a prescriber. CONCLUSION This pilot was the first example of community pharmacists independently prescribing statins outside of the clinic setting. The service could target an important health initiative.
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Tsamlag L, Wang H, Shen Q, Shi Y, Zhang S, Chang R, Liu X, Shen T, Cai Y. Applying the information-motivation-behavioral model to explore the influencing factors of self-management behavior among osteoporosis patients. BMC Public Health 2020; 20:198. [PMID: 32028930 PMCID: PMC7006415 DOI: 10.1186/s12889-020-8292-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 01/28/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The prevalence of osteoporosis (OP) is rapidly increasing. Healthy behaviors are crucial for the management of OP. Application of the information-motivation-behavioral skills (IMB) model has been verified in various chronic diseases, but this model has not been investigated for behavioral interventions among people with OP. This study aimed to examine factors influencing OP self-management behavior and their interaction paths based on the IMB model. METHODS We conducted a cross-sectional study using a convenience sampling method in 20 community health service centers in Shanghai, China. Predictive relationships between IMB model variables and self-management behaviors were evaluated using an anonymous questionnaire. Structural equation modeling was used to test the IMB model. RESULTS In total, 571 participants completed the questionnaire, of which 461 (80.7%) were female. Participants' mean age was 68.8 ± 10.1 years. Only 101 (17.7%) participants were classified as having better OP self-management behaviors. The model demonstrated the data had an acceptable fit. Paths from information to self-efficacy (β = 0.156, P < 0.001) and self-management behaviors (β = 0.236, P < 0.001), from health beliefs to self-efficacy (β = 0.266, P < 0.001), from medical system support to self-efficacy (β = 0.326, P < 0.001) and self-management behaviors (β = 0.230, P < 0.001), and from self-efficacy to self-management behaviors (β = 0.376, P < 0.001) were all significant and in the predicted direction. CONCLUSION This study validated the utility of the IMB model for OP self-management behaviors in this population. Middle-aged and older adult patients with OP have poor self-management behaviors. Enhanced knowledge about OP and is important for improving self-management behaviors.
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Affiliation(s)
- Lhakpa Tsamlag
- Department of Community Health and Behavioral Medicine, School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200025, China
| | - Huwen Wang
- Department of Community Health and Behavioral Medicine, School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200025, China
| | - Qiuming Shen
- Department of Community Health and Behavioral Medicine, School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200025, China
| | - Yue Shi
- Department of Community Health and Behavioral Medicine, School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200025, China
| | - Shuxian Zhang
- Department of Community Health and Behavioral Medicine, School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200025, China
| | - Ruijie Chang
- Department of Community Health and Behavioral Medicine, School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200025, China
| | - Xiyu Liu
- Department of Community Health and Behavioral Medicine, School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200025, China
| | - Tian Shen
- Department of Community Health and Behavioral Medicine, School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200025, China.
| | - Yong Cai
- Department of Community Health and Behavioral Medicine, School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, Shanghai, 200025, China.
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Pourrajab B, Fatahi S, Dehnad A, Kord Varkaneh H, Shidfar F. The impact of probiotic yogurt consumption on lipid profiles in subjects with mild to moderate hypercholesterolemia: A systematic review and meta-analysis of randomized controlled trials. Nutr Metab Cardiovasc Dis 2020; 30:11-22. [PMID: 31748179 DOI: 10.1016/j.numecd.2019.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Potential beneficial effect of probiotic yogurt on the lipid profile has raised much interest. However, the results are inconsistent in this regard. The aim of the study is to determine the effects of probiotic yogurt on serum lipid profile in individuals with mild to moderate hypercholesterolemia. METHODS AND RESULTS Online databases including PubMed, Scopus, ISI Web of Science, Cochrane Central Register of Controlled Trials, Science Direct, Google Scholar and Igaku Chuo Zasshi were searched until March 19th 2019. The effect sizes were expressed as the weighted mean difference (WMD) with 95% confidence interval (CI). Seven eligible trials with 274 participants were included in this systematic review. Pooling of 9 effect sizes from these seven articles revealed a significant reduction in total cholesterol and low density lipoprotein cholesterol levels following probiotic yogurt consumption (mean difference: -8.73 mg/dl, 95% CI: -15.98, -1.48, p-value = 0.018 and mean difference: -10.611 mg/dl, 95% CI: -16.529, -4.693, p-value = 0.000, respectively) without significant heterogeneity among the studies (I2 = 40.6%, p-value = 0.1 and I2 = 24.2%, p-value = 0.229, respectively). The results showed no significant changes in high density lipoprotein cholesterol and triglyceride levels. Also, none of the variables showed a significant change for sensitivity analysis. CONCLUSION Available evidence suggests that probiotic yogurt can significantly reduce total cholesterol and LDL-c in subjects with mild to moderate hypercholesterolemia without a significant effect on HDL-c and triglyceride levels.
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Affiliation(s)
- Behnaz Pourrajab
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, Faculty of Public Health Branch, Iran University of Medical Sciences, Tehran, Iran
| | - Somaye Fatahi
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; Student Research Committee, Faculty of Public Health Branch, Iran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Dehnad
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Kord Varkaneh
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Shidfar
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
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Jeong HY, Lee SY, Kim SH, Kim J. Long-Term Benefit and Withdrawal Effect of Statins After Percutaneous Coronary Intervention: A Nationwide Population-Based Cohort Study. Patient Prefer Adherence 2020; 14:717-724. [PMID: 32308376 PMCID: PMC7147626 DOI: 10.2147/ppa.s245324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/03/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Despite indubitable evidence for the cardiovascular benefits of statins, there have been concerns that statin discontinuation may cause negative effects known as "statin withdrawal syndrome." This study aimed to assess the benefit and the withdrawal effect of statins after percutaneous coronary intervention (PCI). PATIENTS AND METHODS We conducted a retrospective cohort study on 5218 patients who underwent PCI between 2002 and 2013 using the nationwide health insurance claim data in Korea. Based on the prescription data, the use of statins during follow-up was classified into three risk periods: "statin period" (period with statin cover), "statin withdrawal period" (withdrawal of statin within 30 days), and "no statin period" (no exposure to statin for longer than 30 days). The primary outcome was the composite outcome of myocardial infarction, coronary revascularization, stroke, and all-cause death. We performed multivariate Cox proportional regression analyses which treated the use of statins as a time-dependent variable. RESULTS During the follow-up period of 3.54 ± 2.91 years (mean ± standard deviation), 1515 (29.0%) patients sustained a primary outcome. Compared with the "no statin period," the "statin period" was associated with lower risk of the primary outcome (adjusted hazard ratio [HR] 0.72, 95% confidence interval [CI, 0.63-0.81]). While the "statin withdrawal period" posed a significantly increased risk (adjusted HR 1.87, 95% CI [1.52-2.29]). With respect to the intensity of statins associated with withdrawal, dose-dependent increased risk was observed for withdrawal of low-, moderate-, and high-intensity statins; adjusted HR [95% CI] were 1.45 [0.74-2.86], 1.86 [1.49-2.32], and 2.61 [1.41-4.81], respectively. CONCLUSION After PCI, there was an increased cardiovascular risk during the statin withdrawal period, especially with the use of high-intensity statins. To maximize the beneficial effect and to avoid the withdrawal effect of statins, high-risk patients need to adhere to taking statins without discontinuation.
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Affiliation(s)
- Hye Yun Jeong
- Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - So-Young Lee
- Division of Nephrology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Sang Hoon Kim
- Division of Cardiology, Department of Internal Medicine CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
- Sang Hoon Kim Division of Cardiology, Department of Internal Medicine, CHA University School of Medicine, CHA Bundang Medical Center, 59 Yatap-ro, Bundang-gu, Seongnam-si13496, KoreaTel +82-31-780-5585Fax +82-31-780-5857 Email
| | - Jinkwon Kim
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Korea
- Correspondence: Jinkwon Kim Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin-si16995, KoreaTel +82-31-5189-8152Fax +82-31-5189-8208 Email
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Vonbank A, Agewall S, Kjeldsen KP, Lewis BS, Torp-Pedersen C, Ceconi C, Funck-Brentano C, Kaski JC, Niessner A, Tamargo J, Walther T, Wassmann S, Rosano G, Schmidt H, Saely CH, Drexel H. Comprehensive efforts to increase adherence to statin therapy. Eur Heart J 2019; 38:2473-2479. [PMID: 28077470 DOI: 10.1093/eurheartj/ehw628] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/06/2016] [Indexed: 12/26/2022] Open
Affiliation(s)
- Alexander Vonbank
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Stefan Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Keld Per Kjeldsen
- Division of Cardiology, Department of Medicine, Copenhagen University Hospital (Holbaek Hospital), Holbaek, Denmark.,Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Basil S Lewis
- Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine of the Technion (Israel Institute of Technology), Haifa, Israel
| | - Christian Torp-Pedersen
- Health Science and Technology, Aalborg University, Niels Jernes Vej 12, A5-208, 9220 Aalborg, Denmark
| | - Claudio Ceconi
- University Hospital of Ferrara, U.O. Cardiologia, Post Degree School in Cardiology, Heart Failure and Cardiovascular Prevention Unit, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Christian Funck-Brentano
- INSERM, CIC-1421 and UMR ICAN 1166, AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology, Sorbonne Universités, UPMC Univ Paris, 06, Faculty of Medicine, F-75013 Paris, France
| | - Juan Carlos Kaski
- Cardiovascular Sciences Research Centre at St George's, University of London, Cranmer Terrace, London SW17 0RE, Great Britain
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Thomas Walther
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland.,Department of Obstetrics, Center for Perinatal Medicine, University of Leipzig, Leipzig, Germany
| | - Sven Wassmann
- Department of Cardiology, Isar Heart Center, Isarklinikum, Sonnenstr. 24-26, 80331 Munich, Germany
| | - Giuseppe Rosano
- Irccs San Raffaele Hospital, Department of Medical Sciences, Via Della Pisana 235, 00163 Rome, Italy
| | - Harald Schmidt
- Department of Health, Medicine and Life Sciences, Pharmacology, University of Maastricht Universiteitssingel 50, 6229 Maastricht, The Netzerlands
| | - Christoph H Saely
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Heinz Drexel
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein.,College of Medicine, Drexel University, Philadelphia, PA, USA
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Tkachova O, Iakovlieva L, Mitkova Z, Manova M, Savova A, Petrova G. Аn affordability of statins therapy - comparative analysis between Ukraine and Bulgaria. BMC Health Serv Res 2019; 19:902. [PMID: 31775736 PMCID: PMC6882353 DOI: 10.1186/s12913-019-4736-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/12/2019] [Indexed: 12/03/2022] Open
Abstract
Background The statins are а developing group of cardiovascular medicines, widely used for dyslipidemia. As a whole statins consumption leads to reduction in cardiovascular events and death, and improves the disease control. The main study issue considers the differences in an affordability to lipid lowering medicines in the countries with the highest morbidity and mortally rate within and outside EU. The affordability has been researched by exploring the price differences and average wages. Methods On total 7 international nonproprietary names and 19 dosage forms available on both markets are observed during 2013–2016. An average, minimum, and maximum retail prices per DDD, standard deviation (SD) has been calculated for all marketed dosage forms. A price ratio between the minimal and maximal price per DDD is estimated in order to evaluate their difference. Affordability of the treatment is determined as the number of working hours per month needed for patient to purchase medicines for a monthly therapy. Results Large variations of price per DDD, SD and the average price exist between different dosage forms in both countries. The highest value of a price ratio is observed for 5 mg rosuvastatin in Bulgaria and 10 mg rosuvastatin in Ukraine. The number of working hours needed to cover monthly therapy has increased during 2013–2016 in Ukraine. The most affordable is treatment with a generic atorvastatin in Bulgaria and generic rosuvastatin in Ukraine. The most expensive rosuvastatin in Bulgaria and atorvastatin in Ukraine are found as the least affordable for a monthly therapy. Conclusions The decrease of prices for statins is not the only reason influencing patients’ affordability to therapy for statin therapy in Ukraine and Bulgaria. The difference in affordability in Ukraine and Bulgaria is affected mainly by the economic development in the country as well as wages variation.
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Affiliation(s)
- Oksana Tkachova
- Department of Pharmacoeconomics, National University of Pharmacy, 4-Valentinivska str, Kharkiv, 61168, Ukraine.
| | - Larysa Iakovlieva
- Department of Pharmacoeconomics, National University of Pharmacy, 4-Valentinivska str, Kharkiv, 61168, Ukraine
| | - Zornitsa Mitkova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 2-Dunavstr, 1000, Sofia, Bulgaria
| | - Manoela Manova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 2-Dunavstr, 1000, Sofia, Bulgaria
| | - Alexandra Savova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 2-Dunavstr, 1000, Sofia, Bulgaria
| | - Guenka Petrova
- Department of Organization and Economy of Pharmacy, Faculty of Pharmacy, Medical University-Sofia, 2-Dunavstr, 1000, Sofia, Bulgaria
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Bens A, Langballe R, Bernstein JL, Cronin-Fenton D, Friis S, Mellemkjaer L. Preventive drug therapy and contralateral breast cancer: summary of the evidence of clinical trials and observational studies. Acta Oncol 2019; 58:1581-1593. [PMID: 31393200 DOI: 10.1080/0284186x.2019.1643915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Breast cancer patients have a lifelong 2-4-fold increased risk of developing a second primary tumor in the contralateral breast compared with the risk for a first primary breast cancer in the general female population. Prevention of contralateral breast cancer (CBC) has received increased attention during recent decades. Here, we summarize and discuss the available literature on drug preventive therapy and CBC.Results: The endocrine-targetting drugs, tamoxifen and aromatase inhibitors are used as standard adjuvant treatment for estrogen receptor (ER)-positive breast cancer. Both are associated with relative risk reductions of CBC of up to 50%, but incur serious side effects. Several prescription drugs originally developed for other purposes, including bisphosphonates, statins, non-steroidal anti-inflammatory drugs, metformin, anti-hypertensives and retinoids, have shown anti-cancer activity in preclinical models. However, results of observational studies on CBC are sparse and inconsistent, with only statins demonstrating promise as preventive agents and a potential treatment option for ER-negative breast cancer patients.Conclusion: Future studies are needed to assess the effect of statins in risk reduction and to identify other drugs with chemopreventive potential against CBC. Eventually, efforts must be directed towards identifying those breast cancer patients likely to benefit most from specific preventive therapies.
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Affiliation(s)
- Annet Bens
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Rikke Langballe
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | - Søren Friis
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Unit of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lene Mellemkjaer
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
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Abughosh SM, Vadhariya A, Johnson ML, Essien EJ, Esse TW, Serna O, Gallardo E, Boklage SH, Choi J, Holstad MM, Fleming ML. Enhancing Statin Adherence Using a Motivational Interviewing Intervention and Past Adherence Trajectories in Patients with Suboptimal Adherence. J Manag Care Spec Pharm 2019; 25:1053-1062. [PMID: 31556824 PMCID: PMC10398332 DOI: 10.18553/jmcp.2019.25.10.1053] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Statins have been shown to be effective in reducing the occurrence of cardiovascular (CV) events and are widely prescribed for the risk reduction of CV diseases and recurrent CV events. However, poor adherence prevents some patients from receiving the maximum benefit of the therapy. Motivational interviewing (MoI) is a patient-centered collaborative approach that can be used to improve medication adherence. Group-based trajectory modeling depicts patterns of adherence over time and may help tailor the MoI intervention to further enhance adherence. OBJECTIVE To assess the effect of a phone-based MoI intervention tailored by patients' past adherence trajectory in improving adherence to statins among patients in a Medicare Advantage prescription drug plan (MAPD). METHODS Patients continuously enrolled in an MAPD from 2013 to 2017 with a statin prescription between January and June 2015 to allow 2 years of pre-index period and 1 year of follow-up were included in the study. Adherence to statins was measured monthly during the 1-year follow-up as proportion of days covered (PDC) and incorporated into a group-based trajectory model to provide 4 distinct patterns of adherence: adherent, rapid decline, gradual decline, and gaps in adherence. Patients in the 3 nonadherent groups were randomized to either control or intervention. The intervention was an initial counseling call and up to 2 monthly follow-up calls by pharmacy students trained in MoI, providing education consistent with a previously identified pattern of use. Refill data at 6 months post-intervention were evaluated to examine the intervention's effect on PDC, as continuous and dichotomized as PDC ≥ 0.8, as well as discontinuation. Multivariable regression adjusted for baseline demographics, clinical characteristics, and past adherence trajectory. RESULTS There were 152 patients included in the analysis who received MoI phone calls and 304 randomly selected controls. Mean PDC for the intervention group (0.67 ± 0.3) was significantly higher than the control (0.55 ± 0.4; P < 0.001). The intervention group was also less likely to discontinue (OR = 0.38; 95% CI = 0.19-0.76) and more likely to be adherent in the linear regression model (β = 12.4; P < 0.001) as well as in the logistic regression model (OR = 1.87; 95% CI = 1.18-2.95). Previous adherence trajectories were significantly associated with adherence in the follow-up. CONCLUSIONS Patients who received the MoI intervention were more likely to be adherent and less likely to discontinue the statin in the 6 months follow-up compared with controls. Future research can identify other approaches to tailor interventions and expand the intervention to other languages. This intervention may also prove valuable to improve adherence to other medications for chronic and asymptomatic diseases. DISCLOSURES This study was funded by Regeneron Pharmaceuticals, which provided critical input during study design, implementation, and manuscript preparation. Abughosh reports grants from Sanofi, BMS/Pfizer, and Valeant Pharmaceuticals, unrelated to this study. Vadhariya reports a past internship at Regeneron Pharmaceuticals, unrelated to this study. Esse, Serna, and Gallardo are employees of CareAllies, a Cigna subsidiary. Boklage is an employee of Regeneron Pharmaceuticals. Choi was an employee of Sanofi during this study. Johnson, Essien, Fleming, and Holstad have nothing to disclose. A poster based on this study was presented at AMCP Nexus 2018; October 22-25, 2018; Orlando, FL.
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Affiliation(s)
- Susan M. Abughosh
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Aisha Vadhariya
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Michael L. Johnson
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - E. James Essien
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | | | | | | | - Susan H. Boklage
- Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Terrytown, New York
| | - Jeannie Choi
- Health Economics and Value Assessment, Sanofi, Bridgewater, New Jersey
| | - Marcia M. Holstad
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Marc L. Fleming
- Department of Pharmacotherapy, University of North Texas System College of Pharmacy, Dallas
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Stampfer HG, Gabb GM, Dimmitt SB. Why maximum tolerated dose? Br J Clin Pharmacol 2019; 85:2213-2217. [PMID: 31219196 PMCID: PMC6783596 DOI: 10.1111/bcp.14032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/26/2019] [Accepted: 05/24/2019] [Indexed: 02/06/2023] Open
Abstract
A long-established approach to the pharmacological treatment of disease has been to start low and go slow. However, clinicians often prescribe up to maximum tolerated dose (MTD), especially when treating acute and more severe disease, without evidence to show that MTD is more likely to improve outcomes. Cardiovascular guidelines for some indications advocate MTD even in prevention, for example hypercholesterolaemia, without compelling evidence of better outcomes. This review explores the origins and potential problems of prescribing medications at MTD. Oral effective dose 50 (ED50) may be a useful guide for balancing efficacy and safety.
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Affiliation(s)
- Hans G. Stampfer
- Division of Psychiatry, Medical School, Faculty of Health and Medical SciencesUniversity of Western AustraliaCrawleyWestern Australia
| | - Genevieve M. Gabb
- Department of General MedicineRoyal Adelaide HospitalAdelaideSouth Australia
| | - Simon B. Dimmitt
- Division of Internal Medicine, Medical School, Faculty of Health and Medical SciencesUniversity of Western AustraliaCrawleyWestern Australia
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNew South WalesAustralia
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Dimmitt SB, Martin JH. Intensive lipid‐lowering therapy in the 12 months after an acute coronary syndrome in Australia: an observational analysis. Med J Aust 2019; 211:284-284.e1. [DOI: 10.5694/mja2.50324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Simon B Dimmitt
- University of Western Australia Perth WA
- University of Newcastle Newcastle NSW
| | - Jennifer H Martin
- University of Newcastle Newcastle NSW
- Hunter New England Health Newcastle NSW
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Maev IV, Samsonov AA, Palgova LK, Pavlov CS, Shirokova E, Starostin KM. Real-world comorbidities and treatment patterns among patients with non-alcoholic fatty liver disease receiving phosphatidylcholine as adjunctive therapy in Russia. BMJ Open Gastroenterol 2019; 6:e000307. [PMID: 31523440 PMCID: PMC6711446 DOI: 10.1136/bmjgast-2019-000307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/03/2019] [Accepted: 07/12/2019] [Indexed: 02/06/2023] Open
Abstract
Objective Previous research conducted in Russia showed that the number of patients with non-alcoholic fatty liver disease (NAFLD) and associated metabolic comorbidities is large. We conducted an observational study to describe the management of NAFLD in patients with metabolic syndrome in Russia. Design A total of 2843 adult patients from 174 medical sites across 6 federal districts of Russia with newly diagnosed NAFLD, who had at least one of four comorbidities, namely overweight/obesity, hypertension, type 2 diabetes mellitus, and hypercholesterolaemia, and who received phosphatidylcholine (PPC) as an adjunctive treatment to standard care, were enrolled during 2015-2016. Results Overall, 2263 patients (79.6%) had at least two metabolic comorbidities associated with NAFLD; overweight/obesity was the most common comorbidity reported in 2298 patients (80.8%). Simple steatosis was the most frequently identified clinical form of NAFLD, diagnosed in 2128 patients (74.9%). Among hypertensive patients, ACE inhibitors, statins, and sartans were most commonly prescribed. Biguanides were administered in more than half of diabetic patients. In patients with overweight/obesity and hypercholesterolaemia, statins were the most frequently prescribed medications. Almost all patients (2837/2843; 99.8%) were treated with 1.8 g of PPC three times per day. PPC therapy was associated with a 90.5% 6-month compliance rate, high treatment satisfaction, and a favourable safety profile. However, almost 15% of diabetic patients and 40% of overweight/obese patients received no further treatment. Conclusions In Russia, patients with newly diagnosed NAFLD represent a population heavily burdened by comorbidities, mainly overweight/obesity and hypercholesterolaemia. A significant part of these patients did not receive a comprehensive pharmacotherapy, highlighting the existing unmet need in the current management of NAFLD patients with metabolic syndrome in Russia.
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Affiliation(s)
- Igor V Maev
- Department of Propedeutics of Internal Diseases and Gastroenterology, A. I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
| | - Aleksey A Samsonov
- Department of Propedeutics of Internal Diseases and Gastroenterology, A. I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
| | - Liudmila K Palgova
- Clinical Research and Educational Center in Gastroenterology and Hepatology, Institute of High Medical Technologies of St Petersburg University, Saint Petersburg, Russia
| | - Chavdar S Pavlov
- Scientific Research Department of Innovation therapy, I. M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - Elena Shirokova
- Propedeutics of Internal Medicine Department, I. M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
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Rosenzweig JL, Bakris GL, Berglund LF, Hivert MF, Horton ES, Kalyani RR, Murad MH, Vergès BL. Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab 2019; 104:3939-3985. [PMID: 31365087 DOI: 10.1210/jc.2019-01338] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To develop clinical practice guidelines for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM) in individuals at metabolic risk for developing these conditions. CONCLUSIONS Health care providers should incorporate regular screening and identification of individuals at metabolic risk (at higher risk for ASCVD and T2DM) with measurement of blood pressure, waist circumference, fasting lipid profile, and blood glucose. Individuals identified at metabolic risk should undergo 10-year global risk assessment for ASCVD or coronary heart disease to determine targets of therapy for reduction of apolipoprotein B-containing lipoproteins. Hypertension should be treated to targets outlined in this guideline. Individuals with prediabetes should be tested at least annually for progression to diabetes and referred to intensive diet and physical activity behavioral counseling programs. For the primary prevention of ASCVD and T2DM, the Writing Committee recommends lifestyle management be the first priority. Behavioral programs should include a heart-healthy dietary pattern and sodium restriction, as well as an active lifestyle with daily walking, limited sedentary time, and a structured program of physical activity, if appropriate. Individuals with excess weight should aim for loss of ≥5% of initial body weight in the first year. Behavior changes should be supported by a comprehensive program led by trained interventionists and reinforced by primary care providers. Pharmacological and medical therapy can be used in addition to lifestyle modification when recommended goals are not achieved.
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Affiliation(s)
| | | | | | - Marie-France Hivert
- Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | | | - Rita R Kalyani
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Bruno L Vergès
- Centre Hospitalier Universitaire Dijon Bourgogne, Dijon, France
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Gulayin PE, Lozada A, Beratarrechea A, Gutierrez L, Poggio R, Chaparro RM, Santero M, Masson W, Rubinstein A, Irazola V. An Educational Intervention to Improve Statin Use: Cluster RCT at the Primary Care Level in Argentina. Am J Prev Med 2019; 57:95-105. [PMID: 31128958 DOI: 10.1016/j.amepre.2019.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Statins are essential drugs for high cardiovascular disease (CVD) risk management; however, there is still low adherence to good clinical practice guidelines for statin use at the primary care level in low- and middle-income countries. This study aimed to test whether a complex intervention targeting physicians improves treatment and control of hypercholesterolemia among patients with moderate to high CVD risk in Argentina. STUDY DESIGN Cluster RCT. SETTING/PARTICIPANTS Ten primary care centers from the public healthcare system of Argentina. INTERVENTION Primary care physicians in the intervention group received an educational program with three main components: (1) an intensive 2-day training workshop; (2) educational outreach visits; and (3) a mobile health application installed on the physician's smartphones. MAIN OUTCOME MEASURES Reduction in mean low-density lipoprotein cholesterol level, reduction in mean Framingham risk score, proportion of patients receiving an appropriate statin dose, and mean annual number of primary care center visits. RESULTS Data were analyzed in 2017-2018. Between April 2015 and April 2016, a total of 357 participants were enrolled (179 patients in the intervention group and 178 in the control group). The global follow-up rate was 97.2%. At the end of the follow-up period, there was no difference in low-density lipoprotein cholesterol levels in any of the follow-up points among the groups. Mean CVD risk had a significant net difference in the first 6 months in the intervention group versus the control group (-4.0, 95% CI = -6.5, -1.5). At the end of follow-up, there was an absolute 41.5% higher rate of participants receiving an appropriate statin dose in the intervention group versus the control group. CONCLUSIONS Although the intervention did not reach a reduction in cholesterol levels, it had a significant positive impact on the promotion of adequate use of clinical practice guidelines. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02380911.
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Affiliation(s)
- Pablo E Gulayin
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina.
| | | | - Andrea Beratarrechea
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
| | - Laura Gutierrez
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
| | - Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
| | - Raúl Martín Chaparro
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
| | - Walter Masson
- Buenos Aires Italiano Hospital, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
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Vadhariya A, Fleming ML, Johnson ML, Essien EJ, Serna O, Esse T, Choi J, Boklage SH, Abughosh SM. Group-Based Trajectory Models to Identify Sociodemographic and Clinical Predictors of Adherence Patterns to Statin Therapy Among Older Adults. AMERICAN HEALTH & DRUG BENEFITS 2019; 12:202-211. [PMID: 31428238 PMCID: PMC6684050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 02/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The benefits of statins in the prevention of primary and secondary atherosclerotic cardiovascular (CV) disease events have been well documented. Suboptimal adherence is a persistent problem associated with increased CV events and increased healthcare utilization. Proportion of days covered (PDC) is widely used to measure medication adherence, and provides a single value that does not adequately depict different adherence behavior patterns. Group-based trajectory modeling has been used to identify adherence patterns (or trajectories) over time. The identification of characteristics unique to each pattern can help in the early identification of patients who are likely to be poor adherents and can inform the development of interventions. OBJECTIVES To identify distinct trajectories of statin adherence in patients enrolled in a Medicare Advantage plan and the sociodemographic and clinical predictors associated with each trajectory. METHODS Patients were included in the study if they were continuously enrolled in a Medicare Advantage plan between 2013 and 2016 and had a statin prescription between January 2015 and June 2015. We observed each patient for 360 days and computed the monthly PDC. The monthly PDC was incorporated into a group-based trajectory model to provide distinct patterns of adherence. Using group-based trajectory modeling, the patients were categorized into groups based on their adherence patterns. Multinomial logistic regression was performed to identify the sociodemographic and clinical factors associated with each group. RESULTS A total of 7850 patients were included in the analysis and were categorized into 4 distinct groups based on statin adherence-rapid discontinuation (7.8%), gradual decline (16.8%), gaps in adherence (17.2%), and high or nearly perfect adherence (58.2%). Significant predictors of being placed into one or more of the low-adherence trajectories compared with the high-adherence trajectory included sex, age, low-income subsidy, language, Charlson Comorbidity Index score, statin intensity, and 90-day refills. CONCLUSIONS The predictors identified in this study provide valuable insight into patient characteristics that increase the risk for statin nonadherence, which has the potential to inform targeted interventions. Identifying patient trajectories can inform the future development of protocols to individualize appropriate interventions for these patients.
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Affiliation(s)
- Aisha Vadhariya
- PhD Candidate, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, TX
| | - Marc L Fleming
- Associate Professor, University of North Texas System College of Pharmacy, Houston
| | - Michael L Johnson
- Associate Professor, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, TX
| | - E James Essien
- Professor, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, TX
| | - Omar Serna
- Clinical Operations Director at CareAllies, Houston
| | - Tara Esse
- Clinical Program Manager at CareAllies, Houston
| | - Jeannie Choi
- Former Director, Health Economics and Value Assessment, Sanofi
| | | | - Susan M Abughosh
- Associate Professor, Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy
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Ouyang XJ, Zhang YQ, Chen JH, Li T, Lu TT, Bian RW. Situational Analysis of Low-density Lipoprotein Cholesterol Control and the Use of Statin Therapy in Diabetes Patients Treated in Community Hospitals in Nanjing, China. Chin Med J (Engl) 2019; 131:295-300. [PMID: 29363644 PMCID: PMC5798050 DOI: 10.4103/0366-6999.223857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Comprehensive management of diabetes should include management of its comorbid conditions, especially cardiovascular complications, which are the leading cause of morbidity and mortality among patients with diabetes. Dyslipidemia is a comorbid condition of diabetes and a risk factor for cardiovascular complications. Therefore, lipid level management is a key of managing patients with diabetes successfully. However, it is not clear that how well dyslipidemia is managed in patients with diabetes in local Chinese health-care communities. This study aimed to assess how well low-density lipoprotein cholesterol (LDL-C) was managed in Nanjing community hospitals, China. Methods: We reviewed clinical records of 7364 diabetic patients who were treated in eleven community hospitals in Nanjing from October 2005 to October 2014. Information regarding LDL-C level, cardiovascular risk factors, and use of lipid-lowering agents were collected. Results: In patients without history of cardiovascular disease (CVD), 92.1% had one or more CVD risk factors, and the most common CVD risk factor was dyslipidemia. The overall average LDL-C level was 2.80 ± 0.88 mmol/L, which was 2.62 ± 0.90 mmol/L and 2.82 ± 0.87 mmol/L in patients with and without CVD history respectively. Only 38% of all patients met the target goal and 37.3% of patients who took lipid-lowering agents met target goal. Overall, 24.5% of all patients were on lipid-lowering medication, and 36.3% of patients with a CVD history and 20.9% of patients without CVD history took statins for LDL-C management. The mean statin dosage was 13.9 ± 8.9 mg. Conclusions: Only a small portion of patients achieved target LDL-C level, and the rate of using statins to control LDL-C was low. Managing LDL-C with statins in patients with diabetes should be promoted, especially in patients without a CVD history and with one or more CVD risk factors.
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Affiliation(s)
- Xiao-Jun Ouyang
- Center for Chronic Disease and Health Management, Jiangsu Provincial Geriatric Hospital, Nanjing, Jiangsu 210009, China
| | - Yong-Qing Zhang
- Department of Chronic Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu 210009, China
| | - Ji-Hai Chen
- Center for Chronic Disease and Health Management, Jiangsu Provincial Geriatric Hospital, Nanjing, Jiangsu 210009, China
| | - Ting Li
- Center for Chronic Disease and Health Management, Jiangsu Provincial Geriatric Hospital, Nanjing, Jiangsu 210009, China
| | - Tian-Tian Lu
- Center for Chronic Disease and Health Management, Jiangsu Provincial Geriatric Hospital, Nanjing, Jiangsu 210009, China
| | - Rong-Wen Bian
- Center for Chronic Disease and Health Management, Jiangsu Provincial Geriatric Hospital, Nanjing, Jiangsu 210009, China
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Zhang R, Lu X, Wu W, Shang X. Why do patients follow physicians' advice? The influence of patients' regulatory focus on adherence: an empirical study in China. BMC Health Serv Res 2019; 19:301. [PMID: 31077196 PMCID: PMC6511214 DOI: 10.1186/s12913-019-4127-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 04/25/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In general, medical regimens and treatments are more likely to be effective if patients follow their physicians' advice. However, limited studies have focused on the relationship between regulatory focus and patient adherence. This study explores the antecedents of patient adherence employing regulatory focus theory. METHODS This study established a research model consisting of two independent variables, two mediators, one dependent variable, two moderators, three control variables, and six hypotheses. An online survey involving 336 valid responses was conducted to collect data in China. We used structural equation modelling and confirmatory factor analysis to test the hypotheses and to develop the research model. RESULTS The reliability and validity of the measures were accepted. In terms of control variables, age had a positive effect on conservative treatment-related health information seeking behaviour, and patients with different resident statuses held different attitudes towards seeking conservative treatment-related health information. However, educational level did not have any effect on the variables of the research model. The hypothesis testing results corroborate that promotion focus had a positive impact on patients' emerging treatment-related health information seeking behaviour; prevention focus had a positive impact on patients' conservative treatment-related health information seeking behaviour, which had a positive impact on patient adherence. In addition, media campaigns had a positive impact on the relationship between promotion focus and emerging treatment-related health information seeking behaviour, and website reputation had a positive impact on the relationship between prevention focus and conservative treatment-related health information seeking behaviour. CONCLUSIONS Individuals can be encouraged to seek health information and share health-related knowledge through mass media, such as the Internet, when the quality of information, especially information from online sources, is guaranteed. In addition, physicians need to improve their professionalism and expand their knowledge of conservative healthcare. As a further application of our work, an Internet information recommendation system can be designed to recommend different types of health information for users according to their regulatory focus.
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Affiliation(s)
- Runtong Zhang
- School of Economics and Management, Beijing Jiaotong University, Shangyuancun 3, Haidian District, Beijing, 100044 China
| | - Xinyi Lu
- School of Economics and Management, Beijing Jiaotong University, Shangyuancun 3, Haidian District, Beijing, 100044 China
| | - Wen Wu
- School of Economics and Management, Beijing Jiaotong University, Shangyuancun 3, Haidian District, Beijing, 100044 China
| | - Xiaopu Shang
- School of Economics and Management, Beijing Jiaotong University, Shangyuancun 3, Haidian District, Beijing, 100044 China
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Ofori-Asenso R, Jakhu A, Curtis AJ, Zomer E, Gambhir M, Jaana Korhonen M, Nelson M, Tonkin A, Liew D, Zoungas S. A Systematic Review and Meta-analysis of the Factors Associated With Nonadherence and Discontinuation of Statins Among People Aged ≥65 Years. J Gerontol A Biol Sci Med Sci 2019; 73:798-805. [PMID: 29360935 DOI: 10.1093/gerona/glx256] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 01/01/2018] [Indexed: 02/02/2023] Open
Abstract
Background Older individuals (aged ≥65 years) are commonly prescribed statins but may experience a range of barriers in adhering to therapy. The factors associated with poor statin adherence and/or discontinuation among this population have not been comprehensively reviewed. Methods We conducted a systematic review to identify English articles published through December 12, 2016 that reported factors associated with nonadherence and/or discontinuation of statins among older persons. Data were pooled via random-effects meta-analysis techniques. Results Forty-five articles reporting data from more than 1.8 million older statin users from 13 countries were included. The factors associated with increased statin nonadherence were black/non-white race (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.39-1.98), female gender (OR 1.08, 95% CI 1.03-1.13), current smoker (OR 1.12, 95% CI 1.03-1.21), higher copayments (OR 1.38, 95% CI 1.25-1.52), new user (OR 1.58, 95% CI 1.21-2.07), lower number of concurrent cardiovascular medications (OR 1.08, 95% CI 1.06-1.09), primary prevention (OR 1.49, 95% CI 1.40-1.59), having respiratory disorders (OR 1.17, 95% CI 1.12-1.23) or depression (OR 1.11, 95% CI 1.06-1.16), and not having renal disease (OR 1.09, 95% CI 1.04-1.14). The factors associated with increased statin discontinuation were lower income status (OR 1.20, 95% CI 1.06-1.36), current smoker (OR 1.14, 95% CI 1.06-1.23), higher copayment (OR 1.61, 95% CI 1.53-1.70), higher number of medications (OR 1.04, 95% CI 1.01-1.06), presence of dementia (OR 1.18, 95% CI 1.02-1.36), cancer (OR 1.22, 95% CI 1.11-1.33) or respiratory disorders (OR 1.19, 95% CI 1.05-1.34), primary prevention (OR 1.66, 95% CI 1.24-2.22), and not having hypertension (OR 1.13, 95% CI 1.07-1.20) or diabetes (OR 1.09, 95% CI 1.04-1.15). Conclusion Interventions that target potentially modifiable factors including financial and social barriers, patients' perceptions about disease risk as well as polypharmacy may improve statin use in the older population.
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Affiliation(s)
- Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Avtar Jakhu
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Andrea J Curtis
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Manoj Gambhir
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Maarit Jaana Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Melbourne, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Andrew Tonkin
- Cardiovascular Research Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Sophia Zoungas
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Division of Metabolism, Genomics and Ageing, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Ofori-Asenso R, Jakhu A, Zomer E, Curtis AJ, Korhonen MJ, Nelson M, Gambhir M, Tonkin A, Liew D, Zoungas S. Adherence and Persistence Among Statin Users Aged 65 Years and Over: A Systematic Review and Meta-analysis. J Gerontol A Biol Sci Med Sci 2019; 73:813-819. [PMID: 28958039 DOI: 10.1093/gerona/glx169] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/30/2017] [Indexed: 12/31/2022] Open
Abstract
Background Older people (aged ≥ 65 years) have distinctive challenges with medication adherence. However, adherence and persistence patterns among older statin users have not been comprehensively reviewed. Methods As part of a broader systematic review, we searched Medline, Embase, PsycINFO, CINAHL, Database of Abstracts of Reviews of Effects, CENTRAL, and the National Health Service Economic Evaluation Database through December 2016 for English articles reporting adherence and/or persistence among older statin users. Data were analyzed via descriptive methods and meta-analysis using random-effect modeling. Results Data from more than 3 million older statin users in 82 studies conducted in over 40 countries were analyzed. At 1-year follow-up, 59.7% (primary prevention 47.9%; secondary prevention 62.3%) of users were adherent (medication possession ratio [MPR] or proportion of days covered [PDC] ≥ 80%). For both primary and secondary prevention subjects, 1-year adherence was worse among individuals aged more than 75 years than those aged 65-75 years. At 3 and ≥10 years, 55.3% and 28.4% of users were adherent, respectively. The proportion of users persistent at 1-year was 76.7% (primary prevention 76.0%; secondary prevention 82.6%). Additionally, 68.1% and 61.2% of users were persistent at 2 and 4 years, respectively. Among new statin users, 48.2% were nonadherent and 23.9% discontinued within the first year. The proportion of statin users who were adherent based on self-report was 85.5%. Conclusions There is poor short and long term adherence and persistence among older statin users. Strategies to improve adherence and reduce discontinuation are needed if the intended cardiovascular benefits of statin treatment are to be realized.
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Affiliation(s)
- Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Avtar Jakhu
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Andrea J Curtis
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Maarit Jaana Korhonen
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Science, Monash University, Melbourne, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Manoj Gambhir
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Andrew Tonkin
- Cardiovascular Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Sophia Zoungas
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
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73
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Rosenthal MB, Troxel AB, Volpp KG, Stewart WF, Sequist TD, Jones JB, Hirsch AG, Hoffer K, Zhu J, Wang W, Hodlofski A, Finnerty D, Huang JJ, Asch DA. Moderating Effects of Patient Characteristics on the Impact of Financial Incentives. Med Care Res Rev 2019; 76:56-72. [PMID: 29148344 PMCID: PMC6222012 DOI: 10.1177/1077558717707313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While financial incentives to providers or patients are increasingly common as a quality improvement strategy, their impact on patient subgroups and health care disparities is unclear. To examine these patterns, we analyzed data from a randomized clinical trial of financial incentives to lower low-density lipoprotein (LDL) cholesterol levels in patients at risk for cardiovascular disease. Patients with higher baseline LDL experienced greater cholesterol reductions in the shared incentive arm (0.23 mg/dL per unit change in baseline LDL, 95% CI [-0.46, -0.00]) but were also less likely to have medication potency increases in the physician incentive arm ( OR = 0.98, 95% CI [0.97, 0.996]). Uninsured patients and those of race other than Black or White were less likely to have potency increases in the shared incentive arm ( OR = 0.15, 95% CI [0.03, 0.70] and OR = 0.09, 95% CI [0.01, 0.93], respectively). These findings suggest some differential response to incentives, particularly in the form of targeted medication changes.
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Affiliation(s)
| | | | - Kevin G Volpp
- 3 University of Pennsylvania, Philadelphia, PA, USA
- 4 U.S. Department of Veterans Affairs, Washington, DC
| | | | | | | | | | - Karen Hoffer
- 3 University of Pennsylvania, Philadelphia, PA, USA
| | - Jingsan Zhu
- 3 University of Pennsylvania, Philadelphia, PA, USA
| | - Wenli Wang
- 3 University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jack J Huang
- 1 Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David A Asch
- 3 University of Pennsylvania, Philadelphia, PA, USA
- 4 U.S. Department of Veterans Affairs, Washington, DC
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74
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Vonbank A, Drexel H, Agewall S, Lewis BS, Dopheide JF, Kjeldsen K, Ceconi C, Savarese G, Rosano G, Wassmann S, Niessner A, Schmidt TA, Saely CH, Baumgartner I, Tamargo J. Reasons for disparity in statin adherence rates between clinical trials and real-world observations: a review. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 4:230-236. [PMID: 30099530 DOI: 10.1093/ehjcvp/pvy028] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/06/2018] [Indexed: 11/14/2022]
Abstract
With statins, the reported rate of adverse events differs widely between randomized clinical trials (RCTs) and observations in clinical practice, the rates being 1-2% in RCTs vs. 10-20% in the so-called real world. One possible explanation is the claim that RCTs mostly use a run-in period with a statin. This would exclude intolerant patients from remaining in the trial and therefore favour a bias towards lower rates of intolerance. We here review data from RCTs with more than 1000 participants with and without a run-in period, which were included in the Cholesterol Treatment Trialists Collaboration. Two major conclusions arise: (i) the majority of RCTs did not have a test dose of a statin in the run-in phase. (ii) A test dose in the run-in phase was not associated with a significantly improved adherence rate within that trial when compared to trials without a test dose. Taken together, the RCTs of statins reviewed here do not suggest a bias towards an artificially higher adherence rate because of a run-in period with a test dose of the statin. Other possible explanations for the apparent disparity between RCTs and real-world observations are also included in this review albeit mostly not supported by scientific data.
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Affiliation(s)
- Alexander Vonbank
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.,Drexel University College of Medicine, Philadelphia, PA, USA.,Division of Angiology, Swiss Cardiovascular Center, University Hospital Bern, Switzerland
| | - Stefan Agewall
- Department of Cardiology, Ullevål, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Sciences, Søsterhjemmet, University of Oslo, Oslo, Norway
| | - Basil S Lewis
- Lady Davis Carmel Medical Center, Haifa, Israel.,Technion-Israel Institute of Technology, Ruth and Bruce Rappaport School of Medicine, Haifa, Israel
| | - Joern F Dopheide
- Division of Angiology, Swiss Cardiovascular Center, University Hospital Bern, Switzerland
| | - Keld Kjeldsen
- Division of Cardiology, Department of Medicine, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Claudio Ceconi
- Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Gianluigi Savarese
- Department of Medicine, Cardiology Division, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Giuseppe Rosano
- Department of Medical Sciences, Irccs San Raffaele Hospital, Rome, Italy
| | - Sven Wassmann
- Cardiology Pasing, Munich, Germany and University of the Saarland, Homburg, Saar, Germany
| | - Alexander Niessner
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Andersen Schmidt
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,Department of Emergency Medicine, Holbaek Hospital, University of Copenhagen, Denmark
| | - Christoph H Saely
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.,Division of Angiology, Swiss Cardiovascular Center, University Hospital Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, University Hospital Bern, Switzerland
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Ciudad Universitaria, Madrid, Spain
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Catapano AL, Tokgözoğlu L, Mello e Silva A, Bruckert E. Pharmaceutical strategies for reducing LDL-C and risk of cardiovascular disease. ATHEROSCLEROSIS SUPP 2019. [DOI: 10.1016/j.athx.2019.100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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76
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Alwhaibi M, Altoaimi M, AlRuthia Y, Meraya AM, Balkhi B, Aldemerdash A, Alkofide H, Alhawassi TM, Alqasoumi A, Kamal KM. Adherence to Statin Therapy and Attainment of LDL Cholesterol Goal Among Patients with Type 2 Diabetes and Dyslipidemia. Patient Prefer Adherence 2019; 13:2111-2118. [PMID: 31853174 PMCID: PMC6916674 DOI: 10.2147/ppa.s231873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Statins are widely utilized antidyslipidemics with a proven track record of safety and efficacy. However, the efficacy of these therapeutic agents hinges on patients' adherence to their prescribed statins. OBJECTIVE The primary objectives of this study were to examine the relationship between adherence to prescribed statins and its impact on the low-density lipoprotein (LDL) level, and to explore the factors that influence patient adherence to statins among patients with diabetes and dyslipidemia. METHODS This was a retrospective, cross-sectional study using the electronic health records data of adults (≥18 years) with type 2 diabetes and dyslipidemia visiting outpatient clinics at a university-affiliated tertiary care center. Adherence to statin therapy was estimated using the proportion of days covered (PDC). Patients with diabetes were considered adherent to statins if they had a PDC of ≥80%. Treatment success was considered if the LDL level of < 2.6 mmol/L. RESULTS Out of 10,226 of patients with diabetes, 1532 met the inclusion criteria and were included in the study. Seventy-nine percent of the patients with diabetes were on atorvastatin and 21% were on simvastatin. The vast majority of the patients with diabetes (77%) were considered adherent and about 42% achieved LDL-cholesterol goal < 2.6 mmol/L. No association between adherence to statin therapy and LDL goal attainment was observed. Women had lower odds of being adherent to statin therapy (AOR=0.66, 95% CI: 0.49-0.87) compared to men. Further, young adults (18-44 years) had lower odds of being adherent to statin therapy (AOR=0.58, 95% CI: 0.32-0.97) compared to older adults (age>65 years). CONCLUSION The findings of this study highlight the need to examine the impact of adherence to statins on healthcare services utilization due to different complications of uncontrolled dyslipidemia.
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Affiliation(s)
- Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Monira Alwhaibi Department of Clinical Pharmacy, King Saud University, College of Pharmacy, Riyadh11149, Saudi ArabiaTel +966 535384152 Email
| | - Maha Altoaimi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulkarim M Meraya
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Aldemerdash
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M Alhawassi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmajeed Alqasoumi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Khalid M Kamal
- Division of Pharmaceutical, Administrative and Social Sciences, Duquesne University School of Pharmacy, Pittsburgh, PA, USA
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Ofori‐Asenso R, Ilomäki J, Tacey M, Si S, Curtis AJ, Zomer E, Bell JS, Zoungas S, Liew D. Predictors of first-year nonadherence and discontinuation of statins among older adults: a retrospective cohort study. Br J Clin Pharmacol 2019; 85:227-235. [PMID: 30402916 PMCID: PMC6303220 DOI: 10.1111/bcp.13797] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/26/2018] [Accepted: 10/13/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS The aim of this study was to examine the level of and predictors of statin nonadherence and discontinuation among older adults. METHODS Among 22 340 Australians aged ≥65 years who initiated statin therapy from January 2014 to December 2015, we estimated the first-year nonadherence (proportion of days covered [PDC] <0.80) and discontinuation (≥90 days without statin coverage) rates. Predictors of nonadherence and discontinuation were examined via multivariable logistic regression. Analyses were performed separately for general beneficiaries (with a higher co-payment; n = 4841) and concessional beneficiaries (with a lower co-payment; n = 17 499). RESULTS During the one-year follow-up, 55.1% were nonadherent (concessional 52.6%; general beneficiaries 64.2%) and 44.7% discontinued statins (concessional 43.1%; general beneficiaries 50.4%). Among concessional beneficiaries, those aged 75-84 years and ≥85 years were more likely to discontinue than people aged 65-74 years (odds ratio 1.11, 95% confidence interval 1.04-1.19 and 1.38, 1.23-1.54, respectively). Diabetes was associated with an increased likelihood of nonadherence and discontinuation, while hypertension, angina and congestive heart failure were associated with a lower likelihood of nonadherence and discontinuation. Anxiety was associated with an increased likelihood of discontinuation, but polypharmacy (concurrent use of five or more drugs) was associated with a lower likelihood of nonadherence and discontinuation. Statin initiation by a general medical practitioner was associated with both increased likelihood of nonadherence and discontinuation. Similar predictors of nonadherence and discontinuation were identified for the general beneficiaries. CONCLUSIONS Among older adults prescribed statins, first-year nonadherence and discontinuation are high. Specific population subgroups such as people aged ≥85 years, those with diabetes or anxiety may require additional attention to improve statin adherence.
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Affiliation(s)
- Richard Ofori‐Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Mark Tacey
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Si Si
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Andrea J. Curtis
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideAustralia
| | - Sophia Zoungas
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
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Vaccher SJ, Kaldor JM, Callander D, Zablotska IB, Haire BG. Qualitative Insights Into Adherence to HIV Pre-Exposure Prophylaxis (PrEP) Among Australian Gay and Bisexual Men. AIDS Patient Care STDS 2018. [DOI: 10.1089/apc.2018.0106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
| | | | - Denton Callander
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Iryna B. Zablotska
- Westmead Clinical School, University of Sydney Medical School, Sydney, Australia
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Zullig LL, Egbuonu-Davis L, Trasy A, Oshotse C, Goldstein KM, Bosworth HB. Countering clinical inertia in lipid management: Expert workshop summary. Am Heart J 2018; 206:24-29. [PMID: 30290290 DOI: 10.1016/j.ahj.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/07/2018] [Indexed: 12/30/2022]
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80
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Cost-effectiveness and Budget Impact of Treatment with Evolocumab Versus Statins and Ezetimibe for Hypercholesterolemia in Spain. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.rec.2018.05.003 10.1016/j.rec.2018.05.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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81
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Olry de Labry Lima A, Gimeno Ballester V, Sierra Sánchez JF, Matas Hoces A, González-Outón J, Alegre del Rey EJ. Coste-efectividad e impacto presupuestario del tratamiento con evolocumab frente a estatinas y ezetimiba para la hipercolesterolemia en España. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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82
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Mitchell D, Guertin JR, Dubois A, Dubé MP, Tardif JC, Iliza AC, Fanton-Aita F, Matteau A, LeLorier J. A Discrete Event Simulation Model to Assess the Economic Value of a Hypothetical Pharmacogenomics Test for Statin-Induced Myopathy in Patients Initiating a Statin in Secondary Cardiovascular Prevention. Mol Diagn Ther 2018; 22:241-254. [PMID: 29651791 DOI: 10.1007/s40291-018-0323-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Statin (HMG-CoA reductase inhibitor) therapy is the mainstay dyslipidemia treatment and reduces the risk of a cardiovascular (CV) event (CVE) by up to 35%. However, adherence to statin therapy is poor. One reason patients discontinue statin therapy is musculoskeletal pain and the associated risk of rhabdomyolysis. Research is ongoing to develop a pharmacogenomics (PGx) test for statin-induced myopathy as an alternative to the current diagnosis method, which relies on creatine kinase levels. The potential economic value of a PGx test for statin-induced myopathy is unknown. METHODS We developed a lifetime discrete event simulation (DES) model for patients 65 years of age initiating a statin after a first CVE consisting of either an acute myocardial infarction (AMI) or a stroke. The model evaluates the potential economic value of a hypothetical PGx test for diagnosing statin-induced myopathy. We have assessed the model over the spectrum of test sensitivity and specificity parameters. RESULTS Our model showed that a strategy with a perfect PGx test had an incremental cost-utility ratio of 4273 Canadian dollars ($Can) per quality-adjusted life year (QALY). The probabilistic sensitivity analysis shows that when the payer willingness-to-pay per QALY reaches $Can12,000, the PGx strategy is favored in 90% of the model simulations. CONCLUSION We found that a strategy favoring patients staying on statin therapy is cost effective even if patients maintained on statin are at risk of rhabdomyolysis. Our results are explained by the fact that statins are highly effective in reducing the CV risk in patients at high CV risk, and this benefit largely outweighs the risk of rhabdomyolysis.
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Affiliation(s)
- Dominic Mitchell
- Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 850 rue St-Denis, Montréal, QC, H2X 0A9, Canada
| | - Jason R Guertin
- Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, Québec City, QC, Canada
- Centre de Recherche du CHU de Québec, Université Laval, Québec City, QC, Canada
| | - Anick Dubois
- Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- Institut de Cardiologie de Montréal, Montréal, QC, Canada
- Centre de Pharmacogénomique Beaulieu-Saucier de l'Université de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Dubé
- Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- Institut de Cardiologie de Montréal, Montréal, QC, Canada
- Centre de Pharmacogénomique Beaulieu-Saucier de l'Université de Montréal, Montréal, QC, Canada
| | - Jean-Claude Tardif
- Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- Institut de Cardiologie de Montréal, Montréal, QC, Canada
- Centre de Pharmacogénomique Beaulieu-Saucier de l'Université de Montréal, Montréal, QC, Canada
| | - Ange Christelle Iliza
- Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 850 rue St-Denis, Montréal, QC, H2X 0A9, Canada
| | - Fiorella Fanton-Aita
- Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 850 rue St-Denis, Montréal, QC, H2X 0A9, Canada
| | - Alexis Matteau
- Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 850 rue St-Denis, Montréal, QC, H2X 0A9, Canada
- Cardiology Division, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Jacques LeLorier
- Faculté de Médecine, Université de Montréal, Montréal, QC, Canada.
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 850 rue St-Denis, Montréal, QC, H2X 0A9, Canada.
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Chidwick K, Strongman H, Matthews A, Stanway S, Lyon AR, Smeeth L, Bhaskaran K. Statin use in cancer survivors versus the general population: cohort study using primary care data from the UK clinical practice research datalink. BMC Cancer 2018; 18:1018. [PMID: 30348123 PMCID: PMC6196462 DOI: 10.1186/s12885-018-4947-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer survivors may be at increased risk of cardiovascular diseases, but little is known about whether prescribing guidelines for the primary prevention of cardiovascular disease are adequately implemented in these patients. We compared levels of statin initiation and cessation among cancer survivors compared to the general population to determine differences in uptake of pharmaceutical cardiovascular risk prevention measures in these groups. METHODS The study population included individuals aged ≥40 during 2005-13 within the UK Clinical Practice Research Datalink primary care database. Within this population we identified cancer survivors who were alive and under follow-up at least 1 year after diagnosis, and controls with no cancer history. Follow-up time prior to cancer diagnosis was included in the control cohort. Using logistic regression, we compared these groups with respect to uptake of statins within 1 month of a first high recorded cardiovascular risk score. Then, we used Cox modelling to compare persistence on statin therapy (time to statin cessation) between cancer survivors and controls from the main study population who had initiated on a statin. RESULTS Among 4202 cancer survivors and 113,035 controls with a record indicating a high cardiovascular risk score, 23.0% and 23.5% respectively initiated a statin within 1 month (adjusted odds ratio 0.98 [91.8-1.05], p = 0.626). Cancer survivors appeared more likely to discontinue statin treatment than controls (adjusted hazard ratio 1.07 [1.01-1.12], p = 0.02). This greater risk of discontinuing was only evident after the first year of therapy (p-interaction < 0.001). INTERPRETATION Although cardiovascular risk is thought to be higher in cancer survivors compared to the general population, cancer survivors were no more likely to receive statins, and marginally more likely to cease long-term therapy, than general population controls. There may be an opportunity to mitigate the suspected higher cardiovascular risk in the growing population of cancer survivors by improving uptake of lipid-lowering treatment and persistence on therapy.
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Affiliation(s)
| | - Helen Strongman
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Anthony Matthews
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | | | - Liam Smeeth
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Krishnan Bhaskaran
- Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Validation of a clinically-relevant rodent model of statin-associated muscle symptoms for use in pharmacological studies. Toxicol Appl Pharmacol 2018; 360:78-87. [PMID: 30268577 DOI: 10.1016/j.taap.2018.09.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/08/2018] [Accepted: 09/26/2018] [Indexed: 12/28/2022]
Abstract
Various rodent models of statin-associated muscle symptoms (SAMS) have been used to investigate the aetiology of statin myotoxicity. Variability between these models, however, may be contributing to the ambiguity currently surrounding the pathogenesis of SAMS. Furthermore, few studies have assessed the reproducibility of these models. The aim of this study was to compare two established rodent models of statin myotoxicity, differing in treatment duration and dose, to determine which reproducibly caused changes characteristic of SAMS. Isolated skeletal muscle organ bath experiments, biochemical analyses, real-time quantitative-PCR and biometric assessments were used to compare changes in skeletal muscle and renal integrity in statin-treated animals and time-matched control groups. The SIM80 model (80 mg kg-1 day-1 simvastatin for 14 days) produced fibre-selective skeletal muscle damage characteristic of SAMS. Indeed, fast-twitch gastrocnemius muscles showed increased Atrogin-1 expression, reduced peak force of contraction and decreased Myh2 expression while slow-twitch soleus muscles were unaffected. Contrastingly, the SIM50 model (50 mg kg-1 day-1 simvastatin for 30 days) produced little evidence of significant skeletal muscle damage. Neither statin treatment protocol caused significant pathological changes to the kidney. The results of this study indicate that the SIM80 model induces a type of SAMS in rodents that resembles the presentation of statin-induced myalgia in humans. The findings support that the SIM80 model is reproducible and can thus be reliably used as a platform to assess the aetiology and treatment of this condition.
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85
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Mitchell D, Guertin JR, LeLorier J. Value of a Hypothetical Pharmacogenomic Test for the Diagnosis of Statin-Induced Myopathy in Patients at High Cardiovascular Risk. Mol Diagn Ther 2018; 22:641-652. [DOI: 10.1007/s40291-018-0356-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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86
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Pandya A, Asch DA, Volpp KG, Sy S, Troxel AB, Zhu J, Weinstein MC, Rosenthal MB, Gaziano TA. Cost-effectiveness of Financial Incentives for Patients and Physicians to Manage Low-Density Lipoprotein Cholesterol Levels. JAMA Netw Open 2018; 1:e182008. [PMID: 30646152 PMCID: PMC6324619 DOI: 10.1001/jamanetworkopen.2018.2008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Financial incentives shared between physicians and patients were shown to significantly reduce low-density lipoprotein cholesterol (LDL-C) levels in a randomized clinical trial, but it is not known whether these health benefits are worth the added incentive and utilization costs required to achieve them. OBJECTIVE To evaluate the long-term cost-effectiveness of financial incentives on LDL-C level control. DESIGN, SETTING, AND PARTICIPANTS In this economic evaluation, a previously validated microsimulation computer model was parameterized using individual-level data from the randomized clinical trial on financial incentives, National Health and Nutrition Examination Surveys for model population inputs, and other published sources. The study was conducted from April 15, 2016, to March 29, 2018. INTERVENTIONS The following interventions were used: (1) usual care, (2) trial control strategy (increased cholesterol level monitoring and use of electronic pill bottles), (3) financial incentives for physicians, (4) financial incentives for patients, and (5) incentives shared between physicians and patients. MAIN OUTCOMES AND MEASURES Discounted costs (2017 US dollars), lifetime cardiovascular disease risk, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS The model population (n = 1 000 000 [30.7% women]) had similar mean (SD) age (61.5 [11.9] years) and LDL-C level (153.9 mg/dL) as the observed trial population (n = 1503 [42.7% women]; age, 62.0 [8.7] years; and LDL-C level, 160.6 mg/dL). Using base-case assumptions (including a 10-year waning period of LDL-C level reductions), the usual-care strategy was dominated (higher costs and lower QALYs) by all other strategies. Strategies for physician- or patient-only incentives were dominated by the shared-incentives strategy, which had an ICER of $60 000/QALY compared with the trial control strategy. In a sensitivity analysis regarding the duration of LDL-C level reductions, the shared-incentives strategy remained cost-effective (ICERs <$100 000/QALY and <$150 000/QALY) for scenarios with LDL-C level reductions lasting, with linear waning, at least 7 and 5 years, respectively. In the 1-way sensitivity analysis for the time horizon of the analysis, the ICER of the shared-incentives strategy exceeded $100 000/QALY at 11 years and $150 000/QALY at 8 years. In probabilistic sensitivity analysis, the shared-incentives intervention was cost-effective in 69% to 77% of iterations using cost-effectiveness thresholds of $100 000 to $150 000/QALY. Cost-effectiveness results were also sensitive to the duration of intervention costs. CONCLUSIONS AND RELEVANCE This study suggests that the financial incentives shared between patients and physicians for LDL-C level control meet conventional standards of cost-effectiveness, but these results appeared to be sensitive to assumptions about the durations of LDL-C level reductions and years of intervention costs included, as well as to the choice of time horizon.
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Affiliation(s)
- Ankur Pandya
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - David A. Asch
- Department of Information, Decisions and Operations, The Wharton School, University of Pennsylvania, Philadelphia
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Cpl Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kevin G. Volpp
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
- Center for Health Equity Research and Promotion, Cpl Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Stephen Sy
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Andrea B. Troxel
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, New York
| | - Jingsan Zhu
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Milton C. Weinstein
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Meredith B. Rosenthal
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Thomas A. Gaziano
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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87
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Ofori-Asenso R, Ilomäki J, Tacey M, Zomer E, Curtis AJ, Bell JS, Zoungas S, Liew D. Patterns of statin use and long-term adherence and persistence among older adults with diabetes. J Diabetes 2018; 10:699-707. [PMID: 29658177 DOI: 10.1111/1753-0407.12769] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/27/2018] [Accepted: 04/07/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Statins reduce the risk of cardiovascular disease in patients with diabetes. This study examined the prevalence of statin use and assessed long-term adherence and persistence among people aged ≥65 years with diabetes. METHODS Pharmaceutical Benefits Scheme data covering a 10% random sample of the Australian population were analyzed. Among older adults with diabetes, the yearly prevalence of statin use was compared via Poisson regression modeling using 2006 as the reference year. A cohort of 7400 new statin users (mean age 72.9 years; 46.2% female) was followed longitudinally. Adherence was assessed via the proportion of days covered (PDC). Statin discontinuation was defined as the first ≥90 days without statin coverage. RESULTS The prevalence of statin use increased from 52.0% in 2006 to 71.2% in 2016 (age and sex-adjusted rate ratio 1.37; 95% confidence interval 1.33-1.41). No gender differences in statin use were observed, but the likelihood of being dispensed statin decreased with increasing age. Among the longitudinal cohort, the proportion adherent (PDC ≥0.80) decreased from 54.0% at 6 months to 37.0% at 9 years. Over a mean follow-up of 4.9 years, 66.8% discontinued, and the likelihood of stopping statin medication within the first year was 42.7%. No age or gender differences in statin discontinuation were evident. CONCLUSIONS Statin use has increased among older adults with diabetes. However, adherence is low and discontinuation is high. Further investigations into the factors associated with non-adherence or discontinuation of statins are important so as to optimize statin use towards achieving the intended cardiovascular benefits among older people with diabetes.
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Affiliation(s)
- Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Tacey
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrea J Curtis
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sophia Zoungas
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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88
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Lelovas P, Efthimiadou EK, Mantziaras G, Siskos N, Kordas G, Kostomitsopoulos N. In vivo toxicity study of quatro stimuli nanocontainers in pregnant rats: Gestation, parturition and offspring evaluation. Regul Toxicol Pharmacol 2018; 98:161-167. [PMID: 30056247 PMCID: PMC7116984 DOI: 10.1016/j.yrtph.2018.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/25/2022]
Abstract
The aim of the present study was to investigate the impact of intravenous administration of newly fabricated nanocontainers (NCs) on the last third of pregnancy in rats. Fifteen pregnant 3-month-old Wistar rats were separated into 3 groups. On the 15th and 17th day of pregnancy all animals received an intravenous administration of 1 ml of 15 mg of NCs (Group A), 1 ml of 5 mg NCs (Group B) while Control group received 1 ml of 0.9% NaCl. On the 14th and 17th of pregnancy ultrasonography was performed and the parameters evaluated were the width of placenta, the length and width of the embryonic sac, the foetus length and the heart rate. On parturition the number of pups per dam was evaluated. Half of the pups were euthanised the day after parturition and their liver and kidney was histologically evaluated and for the rest of the pups the body growth curve was evaluated until the age of 14 week. At the end of the 14th week the remaining pups were euthanised and their liver and kidney was histologically evaluated. At weaning the dams were euthanised and their liver and kidney was histologically evaluated. Ultrasonography: Baseline measurements of the width of placenta, the length and width of embryonic sac, the foetus length and the heart rate on the 14th day of pregnancy, revealed no statistical significant differences between groups. Comparison of the same values on the 17th day of pregnancy after 2 intravenous administrations of NCs showed no statistical significant effect on the respective parameters. The administration of NCs had no impact on the mean number of pups per dam. Additionally, no impact of the NCs on the body weights of the pups was observed on the 1st day after parturition. Moreover, comparisons between groups, for both sexes showed no difference on growth rate. During the histological evaluation no inflammatory, degenerative or neoplastic lesions were observed as far as the newborn, adult offspring and dams were concerned. According to our results no toxic impact of the low and high doses of the NCs was observed on the parameters selected to be evaluated. Nanocontainers toxicity study. Toxicological study on pregnant rats, foetuses and offspring. Ultrasonographic evaluation. Histological evaluation.
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Affiliation(s)
- P Lelovas
- Clinical, Experimental Surgery, & Translational Research, Biomedical Research Foundation Academy of Athens (BRFAA), Athens, 115 27, Greece.
| | - E K Efthimiadou
- Laboratory for Sol-Gel, Institute of Nanoscience and Nanotechnology, NCSR "Demokritos", 153 10, Ag.Paraskevi Attikis, Greece; Laboratory of Inorganic Chemistry, Chemistry Department, National and Kapodistrian University of Athens, Panepistimioupolis, Zografou, 157 71, Greece
| | - G Mantziaras
- Clinical, Experimental Surgery, & Translational Research, Biomedical Research Foundation Academy of Athens (BRFAA), Athens, 115 27, Greece
| | - N Siskos
- Clinical, Experimental Surgery, & Translational Research, Biomedical Research Foundation Academy of Athens (BRFAA), Athens, 115 27, Greece
| | - G Kordas
- Laboratory for Sol-Gel, Institute of Nanoscience and Nanotechnology, NCSR "Demokritos", 153 10, Ag.Paraskevi Attikis, Greece
| | - N Kostomitsopoulos
- Clinical, Experimental Surgery, & Translational Research, Biomedical Research Foundation Academy of Athens (BRFAA), Athens, 115 27, Greece
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89
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Olry de Labry Lima A, Gimeno Ballester V, Sierra Sánchez JF, Matas Hoces A, González-Outón J, Alegre Del Rey EJ. Cost-effectiveness and Budget Impact of Treatment with Evolocumab Versus Statins and Ezetimibe for Hypercholesterolemia in Spain. ACTA ACUST UNITED AC 2018; 71:1027-1035. [PMID: 29937273 DOI: 10.1016/j.rec.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/21/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES To analyze the cost-effectiveness ratio and budget impact of treatment with evolocumab (PCSK9 inhibitor) for patients in secondary prevention in the Spanish National Health System. METHODS A budget impact analysis, decision tree and Markov models were designed under the public health system perspective, based on the only study with morbidity and mortality data (FOURIER). The alternatives compared were evolocumab vs statins, and dual therapy with ezetimibe in 5% of the population. The measure of effectiveness used was the number of cardiovascular events avoided. Univariate and probabilistic sensitivity analyses were performed. RESULTS The average annual cost of patients receiving evolocumab was 11 134.78€ and 393.83€ for standard treatment (statins plus ezetimibe). The incremental cost-effectiveness ratio was > 600 000 € per avoided cardiovascular event for both assessed outcomes (first: cardiovascular death, myocardial infarction, stroke, and hospitalization due to unstable angina or coronary revascularization; second: includes the first 3 events). To perform the 10-year Markov model, the average cost of standard treatment was 13 948.45€ vs 471 417.37€ with evolocumab. Treatment with evolocumab for patients with familial hypercholesterolemia would cost between 3 and 6.1 million euros, assuming a difference of 2.5 and 5.1 million euros with the standard treatment (2017). This difference would be between 204.3 and 1364.7 million euros (2021) for those with nonfamiliar hypercholesterolemia (secondary prevention). CONCLUSIONS Treatment with evolocumab is associated with a lower frequency of cardiovascular events, but is inefficient for patients suitable to receive this drug in the Spanish National Health System.
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Affiliation(s)
- Antonio Olry de Labry Lima
- Área de Gestión de Servicios y Profesionales de la Salud, Escuela Andaluza de Salud Pública (EASP), Granada, Spain; Instituto de Investigación Biosanitaria (IBS), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain.
| | | | | | - Antonio Matas Hoces
- Centro Andaluz de Información del Medicamento (CADIME), Campus Universitario de Cartuja, Granada, Spain
| | - Julio González-Outón
- Servicio de Admisión, Documentación e Información Sanitaria, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
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90
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Musich S, Wang SS, Schwebke K, Slindee L, Waters E, Yeh CS. Underutilization of Statin Therapy for Secondary Prevention of Cardiovascular Disease Among Older Adults. Popul Health Manag 2018; 22:74-82. [PMID: 29893617 PMCID: PMC6386076 DOI: 10.1089/pop.2018.0051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Secondary cardiovascular disease (CVD) clinical trials have demonstrated that higher intensity levels of statin therapy are more effective than lower levels in reducing mortality rates. Despite updated treatment guidelines, statin therapy may be underutilized, with evidence that females are treated less aggressively than males. The primary objective of this study was to determine the prevalence of statin utilization by varying therapy intensity by sex. The secondary objective was to document the benefits of statin therapy intensity levels on all-cause mortality for males and females. A 25% random sample of adults ≥65 years was utilized to identify those with established CVD. Inclusion criteria included: (1) 12-month pre period and (2) up to 30 months post period. Five categories of statin utilization were established: adherent to high-, moderate-, or low-intensity statin therapy, nonadherent, and no statins. Among eligible insureds (N = 49,530 males; N = 44,710 females), 20% of males and 12% of females were identified as high-intensity statin users. Mortality rates significantly increased similarly for males and females as statin therapy intensity decreased. Likewise, mortality hazard ratios indicated the most benefit from high-intensity statin therapy compared to all other categories. Statin therapy for secondary prevention of CVD is beneficial in reducing mortality for males and females but is underutilized, especially among females. Education programs among patients to increase heart health awareness and among physicians to promote the benefits of updated statin guidelines should be encouraged.
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Affiliation(s)
- Shirley Musich
- 1 Research for Aging Populations , Optum, Ann Arbor, Michigan
| | - Shaohung S Wang
- 1 Research for Aging Populations , Optum, Ann Arbor, Michigan
| | - Kay Schwebke
- 2 Informatics & Data Science , Optum, Ann Arbor, Michigan
| | - Luke Slindee
- 2 Informatics & Data Science , Optum, Ann Arbor, Michigan
| | - Evonne Waters
- 3 Medicare & Retirement, UnitedHealthcare Alliances , Minneapolis, Minnesota
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91
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Lansberg P, Lee A, Lee ZV, Subramaniam K, Setia S. Nonadherence to statins: individualized intervention strategies outside the pill box. Vasc Health Risk Manag 2018; 14:91-102. [PMID: 29872306 PMCID: PMC5973378 DOI: 10.2147/vhrm.s158641] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Poor adherence to statin therapy is linked to significantly increased risk of cardiovascular events and death. Unfortunately, adherence to statins is far from optimal. This is an alarming concern for patients prescribed potentially life-saving cholesterol-lowering medication, especially for those at high risk of cardiovascular events. Research on statin adherence has only recently garnered broader attention; hence, major reasons unique to adherence to statin therapy need to be identified as well as suggestions for countermeasures. An integrated approach to minimizing barriers and enhancing facilitation at the levels of the patient, provider, and health system can help address adherence issues. Health care professionals including physicians, pharmacists, and nurses have an obligation to improve patient adherence, as routine care. In order to achieve sustained results, a multifaceted approach is indispensable.
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Affiliation(s)
- Peter Lansberg
- Department of Pediatrics, University Medical Center, Groningen, the Netherlands
| | - Andre Lee
- Department of Pharmacy, National University of Singapore, Singapore
| | - Zhen-Vin Lee
- Cardiology Unit, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Kannan Subramaniam
- Global Medical Affairs, Asia-Pacific region, Pfizer Australia, West Ryde, NSW, Australia
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92
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Wade RL, Patel JG, Hill JW, De AP, Harrison DJ. Estimation of Missed Statin Prescription Use in an Administrative Claims Dataset. J Manag Care Spec Pharm 2018; 23:936-942. [PMID: 28854076 PMCID: PMC10398034 DOI: 10.18553/jmcp.2017.23.9.936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Nonadherence to statin medications is associated with increased risk of cardiovascular disease and poses a challenge to lipid management in patients who are at risk for atherosclerotic cardiovascular disease. Numerous studies have examined statin adherence based on administrative claims data; however, these data may underestimate statin use in patients who participate in generic drug discount programs or who have alternative coverage. OBJECTIVE To estimate the proportion of patients with missing statin claims in a claims database and determine how missing claims affect commonly used utilization metrics. METHODS This retrospective cohort study used pharmacy data from the PharMetrics Plus (P+) claims dataset linked to the IMS longitudinal pharmacy point-of-sale prescription database (LRx) from January 1, 2012, through December 31, 2014. Eligible patients were represented in the P+ and LRx datasets, had ≥1 claim for a statin (index claim) in either database, and had ≥ 24 months of continuous enrollment in P+. Patients were linked between P+ and LRx using a deterministic method. Duplicate claims between LRx and P+ were removed to produce a new dataset comprised of P+ claims augmented with LRx claims. Statin use was then compared between P+ and the augmented P+ dataset. Utilization metrics that were evaluated included percentage of patients with ≥ 1 missing statin claim over 12 months in P+; the number of patients misclassified as new users in P+; the number of patients misclassified as nonstatin users in P+; the change in 12-month medication possession ratio (MPR) and proportion of days covered (PDC) in P+; the comparison between P+ and LRx of classifications of statin treatment patterns (statin intensity and patients with treatment modifications); and the payment status for missing statin claims. RESULTS Data from 965,785 patients with statin claims in P+ were analyzed (mean age 56.6 years; 57% male). In P+, 20.1% had ≥ 1 missing statin claim post-index; 13.7% were misclassified as nonstatin users; and 14.9% were misclassified as new statin users. MPR was higher in the augmented P+ dataset versus the P+ dataset alone for all patients (79.4% vs. 76.7%, P < 0.001) and new users (61.4% vs. 58.7%, P < 0.001). Similarly, mean PDC was higher in the P+ dataset augmented with LRx versus the P+ dataset alone for all patients (76.0% vs. 74.0%, P < 0.001) and new users (58.5% vs. 56.5%, P < 0.001). Most patients received moderate-intensity statins; few changes in dose, intensity, or discontinuation of statins were observed when the P+ dataset was augmented. The most common reasons for missing data were payment by an alternate third-party program (66.3%) and use of cash, coupon, or discount cards (18.7%). CONCLUSIONS Augmenting commercial claims data with point-of-sale data provides a more accurate assessment of statin use than claims data alone. DISCLOSURES This study was funded by Amgen, which contributed to data interpretation and manuscript preparation. Wade, Hill, and De are employees of QuintilesIMS, which received funding from Amgen for work on this study. Patel and Harrison are employees of Amgen and own Amgen stock/stock options. Study concept and design were contributed by Wade, Hill, Patel, and Harrison. De took the lead in data collection, along with the other authors, and all authors contributed to data analysis. The manuscript was written and revised by all the authors.
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Affiliation(s)
| | | | | | - Ajita P De
- 1 QuintilesIMS, Plymouth Meeting, Pennsylvania
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93
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Affiliation(s)
- Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
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94
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Fung V, Graetz I, Reed M, Jaffe MG. Patient-reported adherence to statin therapy, barriers to adherence, and perceptions of cardiovascular risk. PLoS One 2018; 13:e0191817. [PMID: 29420613 PMCID: PMC5805247 DOI: 10.1371/journal.pone.0191817] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/11/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patient reports of their adherence behaviors, concerns about statins, and perceptions of atherosclerotic cardiovascular disease (ASCVD) risk could inform approaches for improving adherence to statin therapy. We examined these factors and their associations with adherence. METHODS We conducted telephone interviews among a stratified random sample of adults receiving statins within an integrated delivery system (N = 730, 81% response rate) in 2010. We sampled equal numbers of individuals in three clinical risk categories: those with 1) coronary artery disease; 2) diabetes or other ASCVD diagnosis; and 3) no diabetes or ASCVD diagnoses. We assessed 15 potential concerns about and barriers to taking statins, and perceived risk of having a heart attack in the next 10 years (0-10 scale). We calculated the proportion of days covered (PDC) by statins in the last 12 months using dispensing data and used multivariate logistic regression to examine the characteristics associated with non-adherence (PDC<80%). Analyses were weighted for sampling proportions. RESULTS Sixty-one percent of patients with PDC<50% reported not filling a new prescription, splitting or skipping statins, or stopping refilling statins in the last 12 months vs. 15% of those with PDC≥80% (p<0.05). The most commonly reported concerns about statins were preferring to lower cholesterol with lifestyle changes (66%), disliking medications in general (59%), and liver or kidney problems (31%); having trouble remembering to take statins (9%) was the most common reason for taking less than prescribed. In multivariate analyses, clinical risk categories were not significantly associated with odds of non-adherence; however, those with higher perceived risk of heart attack were less likely to be non-adherent. CONCLUSIONS Patient-reported medication-taking behaviors were correlated with statin PDC and those with lower perceived cardiovascular risk were less likely to be adherent. These findings highlight the importance of eliciting from and educating patients on their adherence behaviors and ASCVD risks.
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Affiliation(s)
- Vicki Fung
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ilana Graetz
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Mary Reed
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Marc G. Jaffe
- Resolve to Save Lives, New York, New York, United States of America
- Department of Endocrinology, Kaiser Permanente South San Francisco Medical Center, San Francisco, California, United States of America
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Abstract
Lifestyle modification is the cornerstone of preventing atherosclerotic cardiovascular disease. When this is not sufficient in reducing risk, statin therapy is first line. Heart Outcomes Prevention Evaluation (HOPE-3) was a randomized controlled trial of rosuvastatin versus placebo, which demonstrated a significant net benefit in a lower-risk population without known atherosclerotic cardiovascular disease. There were many novel characteristics about this trial that should not be overlooked. It contained a diverse population and was the first trial to base inclusion solely on easily ascertainable metabolic risk factors. It had high adherence in the statin arm, likely due to several factors, including a run-in phase, close follow-up, and low intolerance of moderate-dose rosuvastatin. Attempting to simulate these could increase adherence among clinic populations. Although HOPE-3 did not demonstrate a significant decrease in cardiovascular events among women, meta-analysis including prior randomized controlled trials still demonstrates significant benefit, supporting prior guidelines for statin therapy in this group. Finally, HOPE-3 provides data that potentially support the legacy effect of statins. Understanding these key points provides additional insight into the benefits of statin therapy.
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Brett J, Boulton M, Fenlon D, Hulbert-Williams NJ, Walter FM, Donnelly P, Lavery BA, Morgan A, Morris C, Watson EK. Adjuvant endocrine therapy after breast cancer: a qualitative study of factors associated with adherence. Patient Prefer Adherence 2018; 12:291-300. [PMID: 29497284 PMCID: PMC5819578 DOI: 10.2147/ppa.s145784] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Despite evidence of the efficacy of adjuvant endocrine therapy (AET) in reducing the risk of recurrence and mortality after treatment for primary breast cancer, adherence to AET is suboptimal. This study aimed to explore factors that influence adherence and nonadherence to AET following breast cancer to inform the development of supportive interventions. METHODS Interviews were conducted with 32 women who had been prescribed AET, 2-4 years following their diagnosis of breast cancer. Both adherers (n=19) and nonadherers (n=13) were recruited. The analysis was conducted using the Framework approach. RESULTS Factors associated with adherence were as follows: managing side effects including information and advice on side effects and taking control of side effects, supportive relationships, and personal influences. Factors associated with nonadherence were as follows: burden of side effects, feeling unsupported, concerns about long-term AET use, regaining normality, including valuing the quality of life over length of life, and risk perception. CONCLUSION Provision of timely information to prepare women for the potential side effects of AET and education on medication management strategies are needed, including provision of timely and accurate information on the efficacy of AET in reducing breast cancer recurrence and on potential side effects and ways to manage these should they arise. Trust in the doctor-patient relationship and clear patient pathways for bothersome side effects and concerns with AET are important. Training and education on AET for GPs should be considered alongside novel care pathways such as primary care nurse cancer care review and community pharmacist follow-up.
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Affiliation(s)
- Jo Brett
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford
- Correspondence: Jo Brett, Faculty of Health and Life Sciences, Oxford Brookes University, Jack Straws Lane, Marston, Oxford OX3 OFL, UK, Tel +44 1865 48 2696, Email
| | - Mary Boulton
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford
| | - Debbie Fenlon
- College of Human and Health Sciences, Swansea University, Swansea, Wales
| | - Nick J Hulbert-Williams
- Department of Psychology, Chester Research Unit for the Psychology of Health, University of Chester, Chester
| | - Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Peter Donnelly
- South Devon Healthcare NHS Foundation Trust, Torbay Hospital, Torquay
| | | | | | | | - Eila K Watson
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford
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97
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K Siddiqui M, Maroteau C, Veluchamy A, Tornio A, Tavendale R, Carr F, Abelega NU, Carr D, Bloch K, Hallberg P, Yue QY, Pearson ER, Colhoun HM, Morris AD, Dow E, George J, Pirmohamed M, Ridker PM, Doney ASF, Alfirevic A, Wadelius M, Maitland-van der Zee AH, Chasman DI, Palmer CNA. A common missense variant of LILRB5 is associated with statin intolerance and myalgia. Eur Heart J 2017; 38:3569-3575. [PMID: 29020356 PMCID: PMC5837247 DOI: 10.1093/eurheartj/ehx467] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/26/2017] [Accepted: 07/24/2017] [Indexed: 12/11/2022] Open
Abstract
Aims A genetic variant in LILRB5 (leukocyte immunoglobulin-like receptor subfamily-B) (rs12975366: T > C: Asp247Gly) has been reported to be associated with lower creatine phosphokinase (CK) and lactate dehydrogenase (LDH) levels. Both biomarkers are released from injured muscle tissue, making this variant a potential candidate for susceptibility to muscle-related symptoms. We examined the association of this variant with statin intolerance ascertained from electronic medical records in the GoDARTS study. Methods and results In the GoDARTS cohort, the LILRB5 Asp247 variant was associated with statin intolerance (SI) phenotypes; one defined as having raised CK and being non-adherent to therapy [odds ratio (OR) 1.81; 95% confidence interval (CI): 1.34-2.45] and the other as being intolerant to the lowest approved dose of a statin before being switched to two or more other statins (OR 1.36; 95% CI: 1.07-1.73). Those homozygous for Asp247 had increased odds of developing both definitions of intolerance. Importantly the second definition did not rely on CK elevations. These results were replicated in adjudicated cases of statin-induced myopathy in the PREDICTION-ADR consortium (OR1.48; 95% CI: 1.05-2.10) and for the development of myalgia in the JUPITER randomized clinical trial of rosuvastatin (OR1.35, 95% CI: 1.10-1.68). A meta-analysis across the studies showed a consistent association between Asp247Gly and outcomes associated with SI (OR1.34; 95% CI: 1.16-1.54). Conclusion This study presents a novel immunogenetic factor associated with statin intolerance, an important risk factor for cardiovascular outcomes. The results suggest that true statin-induced myalgia and non-specific myalgia are distinct, with a potential role for the immune system in their development. We identify a genetic group that is more likely to be intolerant to their statins.
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Affiliation(s)
- Moneeza K Siddiqui
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Cyrielle Maroteau
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Abirami Veluchamy
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Aleksi Tornio
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Roger Tavendale
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Fiona Carr
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Ngu-Uma Abelega
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Dan Carr
- Institute of Translation Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Katyrzyna Bloch
- Institute of Translation Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Par Hallberg
- Department of Medical Sciences, Clinical Pharmacology and Science of Life Laboratory, Uppsala University, 751 85 Uppsala, Sweden
| | - Qun-Ying Yue
- Medical Products Agency, Dag Hammarskjölds väg 42, 75237 Uppsala, Sweden
| | - Ewan R Pearson
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Helen M Colhoun
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
- Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Andrew D Morris
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Eleanor Dow
- Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Jacob George
- Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Munir Pirmohamed
- Institute of Translation Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Paul M Ridker
- Brigham and Women's Hospital, Department of Medicine, Preventive Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Alex S F Doney
- Ninewells Hospital and Medical School, Dundee DD19SY, UK
| | - Ana Alfirevic
- Institute of Translation Medicine, University of Liverpool, Liverpool L69 3BX, UK
| | - Mia Wadelius
- Department of Medical Sciences, Clinical Pharmacology and Science of Life Laboratory, Uppsala University, 751 85 Uppsala, Sweden
| | - Anke-Hilse Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, 3508 TB Utrecht, The Netherlands
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Daniel I Chasman
- Brigham and Women's Hospital, Department of Medicine, Preventive Medicine, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Colin N A Palmer
- Pat McPherson Centre for Pharmacogenetics & Pharmacogenomics, Division of Molecular & Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee DD19SY, UK
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98
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Civeira F, Jarauta E. Vaccine against PCSK9: the natural strategy from passive to active immunization for the prevention of atherosclerosis. J Thorac Dis 2017; 9:4291-4294. [PMID: 29268494 PMCID: PMC5721073 DOI: 10.21037/jtd.2017.10.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/09/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Fernando Civeira
- Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Universidad de Zaragoza, Zaragoza, Spain
| | - Estíbaliz Jarauta
- Hospital Universitario Miguel Servet, IIS Aragon, CIBERCV, Universidad de Zaragoza, Zaragoza, Spain
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99
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Pichardo-Almarza C, Diaz-Zuccarini V. Understanding the Effect of Statins and Patient Adherence in Atherosclerosis via a Quantitative Systems Pharmacology Model Using a Novel, Hybrid, and Multi-Scale Approach. Front Pharmacol 2017; 8:635. [PMID: 28955237 PMCID: PMC5601395 DOI: 10.3389/fphar.2017.00635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Statins are one of the most prescribed drugs to treat atherosclerosis. They inhibit the hepatic HMG-CoA reductase, causing a reduction of circulating cholesterol and LDL levels. Statins have had undeniable success; however, the benefits of statin therapy crystallize only if patients adhere to the prescribed treatment, which is far away from reality since adherence decreases with time with around half of patients discontinue statin therapy within the first year. The objective of this work is to; firstly, demonstrate a formal in-silico methodology based on a hybrid, multiscale mathematical model used to study the effect of statin treatment on atherosclerosis under different patient scenarios, including cases where the influence of medication adherence is examined and secondly, to propose a flexible simulation framework that allows extensions or simplifications, allowing the possibility to design other complex simulation strategies, both interesting features for software development. Methods: Different mathematical modeling paradigms are used to present the relevant dynamic behavior observed in biological/physiological data and clinical trials. A combination of continuous and discrete event models are coupled to simulate the pharmacokinetics (PK) of statins, their pharmacodynamic (PD) effect on lipoproteins levels (e.g., LDL) and relevant inflammatory pathways whilst simultaneously studying the dynamic effect of flow-related variables on atherosclerosis progression. Results: Different scenarios were tested showing the impact of: (1) patient variability: a virtual population shows differences in plaque growth for different individuals could be as high as 100%; (2) statin effect on atherosclerosis: it is shown how a patient with a 1-year statin treatment will reduce his plaque growth by 2-3% in a 2-year period; (3) medical adherence: we show that a patient missing 10% of the total number of doses could increase the plaque growth by ~1% (after 2 years) compared to the same "regular" patient under a 1-year treatment with statins. Conclusions: The results in this paper describe the effect of pharmacological intervention combined with biological/physiological or behavioral factors in atherosclerosis progression and treatment in specific patients. It also provides an exemplar of basic research that can be practically developed into an application software.
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Affiliation(s)
- Cesar Pichardo-Almarza
- Multiscale Cardiovascular Engineering Group (MUSE), Department of Mechanical Engineering, University College LondonLondon, United Kingdom.,Institute of Healthcare Engineering, University College LondonLondon, United Kingdom
| | - Vanessa Diaz-Zuccarini
- Multiscale Cardiovascular Engineering Group (MUSE), Department of Mechanical Engineering, University College LondonLondon, United Kingdom.,Institute of Healthcare Engineering, University College LondonLondon, United Kingdom
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100
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Zhou Z, Albarqouni L, Breslin M, Curtis AJ, Nelson M. Statin-associated muscle symptoms (SAMS) in primary prevention for cardiovascular disease in older adults: a protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2017; 7:e017587. [PMID: 28963307 PMCID: PMC5623566 DOI: 10.1136/bmjopen-2017-017587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Although statins are commonly used for prevention of cardiovascular disease, there is limited evidence about statin-related adverse effects in older people. Statin-related adverse events (AEs), especially the statin-associated muscle symptoms (SAMS), are the most common reasons for their discontinuation. Therefore, it is important to determine the risk of SAMS in the older population. We will undertake a systematic review and meta-analysis primarily focusing on the risk of SAMS and secondarily targeting myopathy, rhabdomyolysis, AEs and serious AEs, dropouts due to SAMS in run-in period, related permanent discontinuation rate of statins and creatine kinase level, among older people who received statins for primary prevention. METHODS AND ANALYSIS This study has been developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. We will include randomised controlled trials in which statin was compared with placebo with at least 1 year follow-up among older adults aged ≥65. This review is an update of a Cochrane systematic review that included the articles published before 2012. Cochrane Central Register of Controlled Trials, Medline OvidSP and Embase electronic database searches will be performed to identify relevant articles, limiting the publication date from 1 January 2012 to 13 February 2017. There will be no language limitation. Two independent reviewers will screen titles and abstracts and full text in duplicate. Risk of bias and evidence quality will be assessed using the Cochrane Collaboration's tool and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively. A meta-analysis using pooled data will be undertaken, if appropriate. We will also perform metaregression and subgroup analyses to identify sources of heterogeneity. ETHICS AND DISSEMINATION This study is exempt from ethics approval due to the anonymous and aggregated data used. The outcomes will be disseminated by conference presentations and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER CRD42017058436.
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Affiliation(s)
- Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Anhui Medical University, Hefei, Anhui, China
| | - Loai Albarqouni
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrea J Curtis
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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