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Koenig W, Lorenz ES, Beier L, Gouni-Berthold I. Retrospective real-world analysis of adherence and persistence to lipid-lowering therapy in Germany. Clin Res Cardiol 2024; 113:812-821. [PMID: 37603070 PMCID: PMC11108924 DOI: 10.1007/s00392-023-02257-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/26/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of mortality in Germany. Cardiovascular risk can be mitigated with long-term lipid-lowering therapies (LLTs) that reduce levels of low-density lipoprotein cholesterol. Although effective, risk mitigation is hindered by poor persistence and adherence. OBJECTIVE To investigate real-world persistence and adherence to LLTs through 36 months post-initiation. METHODS This retrospective cohort study included patients with dyslipidemia who were newly prescribed LLTs between July and December 2017, using anonymized prescription data from the Insight Health™ Patient Insight Tool, and followed up until March 2021. Persistence and adherence to the therapies were stratified by age and sex. The proportion of days covered (PDC) was used to measure adherence. RESULTS Patients with dyslipidemia and newly prescribed statins (n = 865,732), ezetimibe (n = 34,490), or anti-proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (anti-PCSK9 mAbs; n = 1940) were included. Persistence to LLTs declined gradually across all treatment subgroups and was lower in women than men. Adherence, calculated as the mean PDC at the end of the analysis period (July 2017‒March 2021) was 0.84, 0.92, and 0.93 for statins, ezetimibe, and anti-PCSK9 mAbs, respectively. Among patients who discontinued treatment, mean treatment duration was 265, 255, and 387 days for statins, ezetimibe, and anti-PCSK9 mAbs, respectively. Only ~ 10% of patients persisted between 201 and 300 days. By Day 300, 71% of patients on statins had discontinued treatment. At 36 months, overall persistence rates were lowest with statins (20.6%), followed by ezetimibe (22.3%) and anti-PCSK9 mAbs (50.9%). CONCLUSIONS High non-persistence rates were observed across all LLT regimens analyzed, with the lowest persistence rates observed with statins.
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Affiliation(s)
- Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
| | - Elke S Lorenz
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Lea Beier
- Novartis Pharma GmbH, Nuremberg, Germany
| | - Ioanna Gouni-Berthold
- Center for Endocrinology, Diabetes, and Preventive Medicine, Faculty of Medicine, University of Cologne, University Hospital Cologne, Cologne, Germany
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Terentes-Printzios D, Dima I, Benardos P, Mitrou P, Mathioudakis K, Tsolakidis A, Barkas F, Tsioufis K, Sfikakis PP, Liberopoulos E, Vlachopoulos C. Real-world data on treatment patterns in at least high cardiovascular risk patients on dual and triple lipid lowering therapy in a Hellenic nationwide e-prescription database. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200261. [PMID: 38623144 PMCID: PMC11017038 DOI: 10.1016/j.ijcrp.2024.200261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/12/2024] [Indexed: 04/17/2024]
Abstract
Background Despite recent guidelines appropriate lipid-lowering treatment (LLT) remains suboptimal in everyday clinical practice. Aims We aimed to describe clinical practice of use of LLT for at least high CV risk populations in a Hellenic real-world setting and assess how this relates to the European Society of Cardiology treatment guidelines. Methods We analyzed data from a retrospective cohort study of the National Registry of patients with dyslipidemia between 1/7/2017 and 30/6/2019 who were at least of high CV risk and filled a dual or triple lipid-lowering treatment (dLLT, tLLT) prescription. The primary outcomes of interest of this analysis were to report on the patterns of LLT use in at least high CV risk patients. Results A total of 994,255 (45.4% of Greeks on LLT) were of at least high CV risk and 120,490 (5.5%) were on dLLT or tLLT. The percentage of patients with reported statin intolerance ranged from 2 to 10%. While persistence was reported to be satisfactory (>85% for both dLLT or tLLT), adherence was low (ranging between 14 and 34% for dLLT). In 6-month intervals, the percentage of patients achieving a low-density lipoprotein cholesterol (LDL-C) target below 100 md/dL ranged from 20% to 23% for dLLT and 34%-37% for tLLT. Conclusions The prevalence of at least high CV risk patients among patients receiving LLT in Greece is substantial. Despite the high persistence and probably due to the low adherence to treatment, LDL-C remains above targets in more than two thirds of patients.
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Affiliation(s)
- Dimitrios Terentes-Printzios
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Ioanna Dima
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Panorios Benardos
- National Technical University of Athens, School of Mechanical Engineering, Section of Manufacturing Technology, Heroon Polytechniou 9, Athens, GR15780, Greece
| | - Panagiota Mitrou
- Independent Department of Therapeutic Protocols and Patient Registries, Hellenic Republic Ministry of Health, Athens, Greece
| | | | | | - Fotios Barkas
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic and Internal Medicine National and Kapodistrian University of Athens Medical School, Athens, 11527, Greece
| | - Evangelos Liberopoulos
- First Department of Propaedeutic and Internal Medicine National and Kapodistrian University of Athens Medical School, Athens, 11527, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Greece
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Manolis AA, Manolis TA, Mikhailidis DP, Manolis AS. Are We Using Ezetimibe As Much As We Should? Biomark Insights 2024; 19:11772719241257410. [PMID: 38827240 PMCID: PMC11143858 DOI: 10.1177/11772719241257410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 05/09/2024] [Indexed: 06/04/2024] Open
Abstract
Lipid-lowering therapies, particularly non-statin regimens, are underutilized as ~2/3 of patients with atherosclerotic cardiovascular (CV) disease (CVD) are not optimally managed, and do not attain target low-density lipoprotein cholesterol (LDL-C) concentrations, despite statin treatment. Statins have been the mainstay of hypolipidemic therapies; however, they are plagued by adverse effects, which have partly hindered their more widespread use. Ezetimibe is often the first added mode of treatment to attain LDL-C goals as it is efficacious and also allows the use of a smaller dose of statin, while the need for more expensive therapies is obviated. We herein provide a comprehensive review of the effects of ezetimibe in lipid lowering and reducing CV events and improving outcomes. Of the hypolipidemic therapies, oral ezetimibe, in contrast to newer agents, is the most convenient and/or affordable regimen to be utilized as mono- or combined therapy supported by data from CV outcomes studies attesting to its efficacy in reducing CVD risk and events. When combined with a statin, the statin dose could be lower, thus curtailing side-effects, while the hypolipidemic effect is enhanced (by ~20%) as the percentage of patients with target level LDL-C (<70 mg/dL) is higher with combined treatment versus a high-intensity statin. Ezetimibe could also serve as an alternative treatment in cases of statin intolerance. In conclusion, ezetimibe has an excellent safety/tolerability profile; it is the first added treatment to a statin that can attain LDL-C targets. In the combined therapy, the hypolipidemic effect is enhanced while the dose of statin could be lower, thus limiting the occurrence of side-effects. Ezetimibe could also serve as an alternative mode of treatment in cases of statin intolerance.
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Affiliation(s)
| | | | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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Kardas P, Kwiatek A, Włodarczyk P, Urbański F, Ciabiada-Bryła B. Statins use amidst the pandemic: prescribing, dispensing, adherence, persistence, and correlation with COVID-19 statistics in nationwide real-world data from Poland. Front Pharmacol 2024; 15:1350717. [PMID: 38655185 PMCID: PMC11035734 DOI: 10.3389/fphar.2024.1350717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
Background Adherence to medications presents a significant challenge in healthcare. Statins, used in primary and secondary prevention of cardiovascular disease, are of particular importance for public health. The outbreak of the COVID-19 pandemic resulted in additional healthcare system-related barriers impeding the execution of therapies. This study aimed to assess the use of as well as adherence and persistence to statins in a national cohort of 38 million of Polish citizens during pandemic. Methods A retrospective analysis of prescription and dispensation data for all statins users from the national payer organization covering the years 2020-2022 was conducted. Medication adherence was assessed using the Medication Possession Ratio, for persistence the 30-day cut-off was accepted. National data on COVID-19 cases and COVID-19 related deaths were obtained from ECDC. Results The analysis identified 7,189,716 Polish citizens (approximately 19% of Polish population) who were dispensed at least 1 pack of statins within the study period. Over that time, there was a continuous significant increasing trend in prescribing and dispensing of statins. Despite a total increase of 18.9% in the number of prescribed tablets, the percentage of tablets dispensed remained similar, averaging 86%. Overall percentage of adherent patients was 48.2%. For a random sample of 100,000 patients, the mean period of continuous therapy in 2022 was 6.2+/- 5.3 months. During the lockdown period, the mean number of prescribed and dispensed tablets was lower by 6.8% and 5.9%, respectively (p < 0.05). However, fluctuations in the number of COVID-19 cases or COVID-19-related deaths per week had no major impact on the prescribing and dispensing of statins. Conclusion Over the time of pandemic, there was a continuous increase in the number of statin tablets prescribed and dispensed in Poland. This suggests that, despite the potential limitations posed by COVID-19, access to statins remained easy, which may be attributed to the mass-scale implementation of the national e-prescription system. However, it is crucial to realise that approximately 1/7 of prescribed statin doses were never dispensed, and the overall levels of adherence and persistence were low. This underscores the necessity for concerted efforts to change this scenario in Poland.
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Affiliation(s)
- Przemysław Kardas
- Medication Adherence Research Centre, Department of Family Medicine, Medical University of Lodz, Łódź, Poland
| | | | | | | | - Beata Ciabiada-Bryła
- Department of Preventive Medicine, Faculty of Health Sciences, Medical University of Lodz, Łódź, Poland
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Deo SV, Al-Kindi S, Virani SS, Fremes S. Novel therapies to achieve the recommended low-density lipoprotein cholesterol concentration (LDL-C) targets for patients after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2024; 167:723-730.e4. [PMID: 37286075 DOI: 10.1016/j.jtcvs.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio; School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
| | - Sadeer Al-Kindi
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Salim S Virani
- The Aga Khan University, Karachi, Pakistan; Texas Heart Institute and Baylor College of Medicine, Houston, Tex
| | - Stephen Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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McKoy JN, Kalich BA, Greene L, Mackey RH, Rosenthal NA, Khan Y, Wójcik C, Jones J, Carabuena LA. LOGAN-CV: A Prospective Study of a Multifaceted Intervention Targeting United States Clinicians to Improve Guideline-Based Management of Lipid-Lowering Therapy. Adv Ther 2024; 41:451-463. [PMID: 37989909 PMCID: PMC10796413 DOI: 10.1007/s12325-023-02716-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/18/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION The 2018 American Heart Association (AHA)/American College of Cardiology (ACC)/Multisociety blood cholesterol guidelines recommend clinicians consider adding non-statin therapy for patients with very high-risk (VHR) atherosclerotic cardiovascular disease (ASCVD) and low-density lipoprotein cholesterol (LDL-C) ≥ 70 mg/dl while receiving maximally tolerated statins. However, according to a recent study, only 17.1% of patients with established ASCVD received appropriate lipid-lowering therapy (LLT) intensification. Here, we describe the design of a prospective, 12-month study (LOGAN-CV) evaluating a multifaceted site-level intervention to enhance clinicians' adherence to guidelines to improve LDL-C levels for patients with VHR ASCVD. METHODS Clinicians from up to ten research sites are eligible if they care for adult patients with ASCVD. Interventions include educational modules, a cloud-based performance platform providing clinicians a tailored summary of their LDL-C management performance, newsletters, periodic peer-to-peer calls, and pre- and post-intervention surveys evaluating knowledge, attitudes, and beliefs around LDL-C management, with additional interventions for clinicians demonstrating a lower readiness to make treatment decisions based on guideline recommendations. Patients with VHR ASCVD, defined as having recent myocardial infarction and LDL-C ≥ 70 mg/dl despite statin treatment, will be included in the study. Patient data will be collected from electronic medical records from baseline (clinician enrollment) through the 12-month intervention. The study started in October 2022, with anticipated completion in March 2024. PLANNED OUTCOMES The change in proportion of patients with LDL-C < 70 mg/dl achieved at any time during the 12-month intervention (primary); LLT intensification, changes in guideline-aligned LDL-C testing and LLT titration over 12 months, and change in overall clinicians' knowledge, attitudes, and beliefs are key outcomes of interest. The LOGAN-CV study addresses a critical unmet need in LDL-C control in patients with VHR ASCVD and evaluates the effect of a multifaceted intervention targeting clinicians to improve their adherence to guidelines and consequently improve clinical outcomes for patients.
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Affiliation(s)
- J Nikki McKoy
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Place, Charlotte, NC, 28277, USA.
| | | | - Laura Greene
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Place, Charlotte, NC, 28277, USA
| | - Rachel H Mackey
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Place, Charlotte, NC, 28277, USA
- Pitt Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ning A Rosenthal
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Place, Charlotte, NC, 28277, USA
| | - Yosef Khan
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Place, Charlotte, NC, 28277, USA
| | - Cezary Wójcik
- Amgen Inc., Thousand Oaks, CA, USA
- Oregon Health and Science University, Portland, OR, USA
| | | | - Leslie A Carabuena
- PINC AI™ Applied Sciences, Premier Inc., 13034 Ballantyne Corporate Place, Charlotte, NC, 28277, USA
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Masana L, Díaz Moya G, Pérez de Isla L. Patients who suffer a first atherosclerotic cardiovascular event while taking statins are often far off of lipid targets. Nutr Metab Cardiovasc Dis 2024; 34:90-97. [PMID: 38092606 DOI: 10.1016/j.numecd.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND AND AIMS Despite considerable evidence that lipid-lowering therapies (LLTs) afford clinical benefit, the control of low-density lipoprotein cholesterol (LDL-C) is suboptimal, and available LLTs are underused, especially in patients at high and very high cardiovascular (CV) risk. This study assesses the real-world LDL-C target attainment rate in patients on LLT before experiencing a first major acute cardiovascular event (MACE). METHODS AND RESULTS The HEARTBEAT was a retrospective, multicentre observational study. From March to June 2021 a total of 334 patients on LLT who had a first MACE while being on statins were included in the study. Of these patients, 83.2 % had a high (40.7 %) or very high CV risk (29.0 %) prior to MACE. Overall, 87.5 % and 89.7 % of the patients at high and very high CV risk, respectively, failed to reach the LDL-C target. Regarding LLTs, only 11.8 % and 19.6 % of the patients at high and very high risk had received high-intensity LLTs prior to MACE. It was estimated that if these patients had reached their recommended LDL-C targets, the risk of MACE may have been reduced by a median of 24.5 % and 23.2 % in patients at high and very high risk respectively. CONCLUSIONS Patients who suffer a first MACE while on statin therapy often were at high/very high CV risk. Despite their risk, LDL-levels and being on statins they are undertreated, and too far from lipid targets. A proper use of high-intensity LLTs led to an increase attainment of LDL targets and lower CV events.
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Affiliation(s)
- Luis Masana
- Unidad Medicina Vascular y Metabolismo, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, IISPV, CIBERDEM, Reus, Spain.
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Filipiak KJ, Barrios V, Ferri C, Fozilov K, Freire Castro SJ, Kuzior A, Martinez-Martin FJ, Mullabaeva G, Nguyen LH, Nizamov U, Tomaszuk-Kazberuk A, Trigulova R, Gąsecka A. STRUGGLE FOR. Italian-Polish-Spanish-Uzbek-Vietnamese Expert Forum Position Paper 2023 for better control of classical modifiable risk factors in clinical practice. Cardiol J 2023; 30:859-869. [PMID: 37987561 PMCID: PMC10713228 DOI: 10.5603/cj.96912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 11/22/2023] Open
Abstract
The progress in pharmacotherapy that has been made in recent years, including the introduction of very effective and safe lipid-lowering and antihypertensive drugs, has not yet translated into the expected universal control of blood pressure, lipid disorders and diabetes. In the STRUGGLE FOR Italian- -Polish-Spanish-Uzbek-Vietnamese Expert Forum Position Paper 2023, experts from five countries recounted several points about the paradigms of cardiological and cardiometabolic care for better control of classical modifiable risk factors in the year 2023. It is believed herein, that the need to intensify treatment, actively search for patients with cardiovascular risk factors, especially with arterial hypertension, hypercholesterolemia and diabetes, should go hand in hand with the implementation of the latest therapy, based on single pill combinations including proven, effective antihypertensive, lipid-lowering and antidiabetic molecules, many of which are listed in the present document. There is a need to use both new technological concepts, completely new drugs, as well as novel treatment concepts such as metabolic treatment in coronary artery disease, try to intensify the fight against smoking in every way, including the available range of drugs and procedures reducing the harm. This approach will provide substantially better control of the underlying cardiovascular risk factors in countries as varied as Italy, Poland, Spain, Uzbekistan and Vietnam.
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Affiliation(s)
- Krzysztof J Filipiak
- Institute of Clinical Science, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Vivencio Barrios
- Cardiology Department, University Hospital Ramon y Cajal, Alcalá University, Madrid, Spain
| | - Claudio Ferri
- University of L'Aquila, MeSVA Department, UOC Internal Medicine and Nephrology, Hypertension and Cardiovascular Prevention Unit, San Salvatore Hospital, Coppito, AQ, Italy
| | - Khurshid Fozilov
- Republican Specialised Center of Cardiology, Tashkent, Uzbekistan
| | | | - Agnieszka Kuzior
- Endocrinology and Nutrition Department at Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Spain
| | - Francisco Javier Martinez-Martin
- Endocrinology and Nutrition Department at Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Spain
- Endocrinology and Nutrition Department at Hospital Universitario de Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | - Guzal Mullabaeva
- Department of Mini-invasive Cardiac Surgery and Rehabilitation, Republican Specialised Center of Cardiology, Tashkent, Uzbekistan
| | - Lan Hieu Nguyen
- Cardiology Department, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Ulugbek Nizamov
- Republican Specialised Center of Cardiology, Tashkent, Uzbekistan
| | - Anna Tomaszuk-Kazberuk
- Department of Cardiology, Lipidology and Internal Medicine with Intensive Cardiac Care Unit, Medical University of Bialystok, Poland
| | - Raisa Trigulova
- Department of Ischemic Heart Disease and Atherosclerosis, Republican Specialised Center of Cardiology, Tashkent, Uzbekistan
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland.
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Zuin M, Rigatelli G, Temporelli P, Di Fusco SA, Colivicchi F, Pasquetto G, Bilato C. Trends in acute myocardial infarction mortality in the European Union, 2012-2020. Eur J Prev Cardiol 2023; 30:1758-1771. [PMID: 37379577 DOI: 10.1093/eurjpc/zwad214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 06/30/2023]
Abstract
AIMS To assess the sex- and age-specific trends in acute myocardial infarction (AMI) mortality in the modern European Union (EU-27) member states between years 2012 and 2020. METHODS AND RESULTS Data on cause-specific deaths and population numbers by sex for each country of the EU-27 were retrieved through a publicly available European Statistical Office (EUROSTAT) dataset for the years 2012 to 2020. AMI-related deaths were ascertained when codes for AMI (ICD-10 codes I21.0-I22.0) were listed as the underlying cause of death in the medical death certificate. Deaths occurring before the age of 65 years were defined as premature deaths. To calculate annual trends, we assessed the average annual percent change (AAPC) with relative 95% confidence intervals (CIs) using joinpoint regression. During the study period, 1 793 314 deaths (1 048 044 males and 745 270 females) occurred in the EU-27 due to of AMI. The proportion of AMI-related deaths per 1000 total deaths decline from 5.0% to 3.5% both in the entire population (P for trend < 0.001) and in males or females, separately. Joinpoint regression analysis revealed a continuous linear decrease in age-adjusted AMI-related mortality from 2012 to 2020 among EU-27 members [AAPC: -4.6% (95% CI: -5.1 to -4.0), P < 0.001]. The age-adjusted mortality rate showed a plateau in some Eastern European countries and was more pronounced in EU-27 females and in subjects aged ≥65 years. CONCLUSION Over the last decade, the age-adjusted AMI-related mortality has been continuously declining in most of the in EU-27 member states. However, some disparities still exist between western and eastern European countries.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Via Aldo Moro, 8, Ferrara 44100, Italy
- Department of Cardiology, West Vicenza Hospital, via del Parco 1, 30671, Arzignano, Italy
| | - Gianluca Rigatelli
- Department of Cardiology, Ospedali Riuniti Padova Sud, Via Albere 30, 35043, Monselice, Italy
| | - Pierluigi Temporelli
- Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, via per Revislate 13, 28013, Gattico-Veruno, Italy
| | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, via Giovanni Martinotti 20, 00135 Rome, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, via Giovanni Martinotti 20, 00135 Rome, Italy
| | - Giampaolo Pasquetto
- Department of Cardiology, Ospedali Riuniti Padova Sud, Via Albere 30, 35043, Monselice, Italy
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, via del Parco 1, 30671, Arzignano, Italy
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Toplak H, Bilitou A, Alber H, Auer J, Clodi M, Ebenbichler C, Fließer-Görzer E, Gelsinger C, Hanusch U, Ludvik B, Maca T, Schober A, Sock R, Speidl WS, Stulnig TM, Weitgasser R, Zirlik A, Koch M, Wienerroither S, Wolowacz SE, Diamand F, Catapano AL. Simulation of bempedoic acid and ezetimibe in the lipid-lowering treatment pathway in Austria using the contemporary SANTORINI cohort of high and very high risk patients. Wien Klin Wochenschr 2023:10.1007/s00508-023-02221-4. [PMID: 37286910 DOI: 10.1007/s00508-023-02221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/07/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The low-density lipoprotein cholesterol goals in the 2019 European Society of Cardiology/European Atherosclerosis Society dyslipidaemia guidelines necessitate greater use of combination therapies. We describe a real-world cohort of patients in Austria and simulate the addition of oral bempedoic acid and ezetimibe to estimate the proportion of patients reaching goals. METHODS Patients at high or very high cardiovascular risk on lipid-lowering treatments (excluding proprotein convertase subtilisin/kexin type 9 inhibitors) from the Austrian cohort of the observational SANTORINI study were included using specific criteria. For patients not at their risk-based goals at baseline, addition of ezetimibe (if not already received) and subsequently bempedoic acid was simulated using a Monte Carlo simulation. RESULTS A cohort of patients (N = 144) with a mean low-density lipoprotein cholesterol of 76.4 mg/dL, with 94% (n = 135) on statins and 24% (n = 35) on ezetimibe monotherapy or in combination, were used in the simulation. Only 36% of patients were at goal (n = 52). Sequential simulation of ezetimibe (where applicable) and bempedoic acid increased the proportion of patients at goal to 69% (n = 100), with a decrease in the mean low-density lipoprotein cholesterol from 76.4 mg/dL at baseline to 57.7 mg/dL overall. CONCLUSIONS The SANTORINI real-world data in Austria suggest that a proportion of high and very high-risk patients remain below the guideline-recommended low-density lipoprotein cholesterol goals. Optimising use of oral ezetimibe and bempedoic acid after statins in the lipid-lowering pathway could result in substantially more patients attaining low-density lipoprotein cholesterol goals, likely with additional health benefits.
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Affiliation(s)
- Hermann Toplak
- Department of Endocrinology and Diabetes, Clinic for Diabetology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | | | - Hannes Alber
- Department of Internal Medicine and Cardiology, KABEG Clinic Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Johann Auer
- Department of Internal Medicine I, Hospital St. Josef Braunau, Braunau, Austria
| | - Martin Clodi
- Hospital of Internal Medicine Brüder Linz, Linz, Austria
- Institute for Cardiovascular and Metabolic Research (ICMR), Johannes Kepler Universität Linz (JKU Linz), Linz, Austria
| | | | | | | | - Ursula Hanusch
- Centre for Clinical Studies Dr. Hanusch GmbH, Vienna, Austria
| | - Bernhard Ludvik
- Medical Department in Diabetology, Endocrinology and Nephrology and Karl Landsteiner Institute for Obesity and Metabolic Disorders, Landstraße Clinic, Vienna, Austria
| | - Thomas Maca
- Evangelical Hospital Vienna, Vienna, Austria
| | - Andreas Schober
- Department of Cardiology, Hospital North-Clinic Floridsdorf, Vienna, Austria
| | | | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas M Stulnig
- Department of Medicine III and Karl Landsteiner Institute for Metabolic Diseases and Nephrology, Clinic Hietzing, Vienna, Austria
| | - Raimund Weitgasser
- Department of Internal Medicine / Diabetology, Wehrle-Diakonissen Private Hospital, Salzburg, Austria
| | - Andreas Zirlik
- Clinical Department of Cardiology, University Clinic Graz, Graz, Austria
| | - Marina Koch
- Daiichi Sankyo Austria GmbH, Vienna, Austria
| | | | | | | | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan and Multimedica IRCCS, Milan, Italy
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11
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Ray KK, Haq I, Bilitou A, Manu MC, Burden A, Aguiar C, Arca M, Connolly DL, Eriksson M, Ferrières J, Laufs U, Mostaza JM, Nanchen D, Rietzschel E, Strandberg T, Toplak H, Visseren FL, Catapano AL. Treatment gaps in the implementation of LDL cholesterol control among high- and very high-risk patients in Europe between 2020 and 2021: the multinational observational SANTORINI study. Lancet Reg Health Eur 2023; 29:100624. [PMID: 37090089 PMCID: PMC10119631 DOI: 10.1016/j.lanepe.2023.100624] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
Background European data pre-2019 suggest statin monotherapy is the most common approach to lipid management for preventing cardiovascular (CV) events, resulting in only one-fifth of high- and very high-risk patients achieving the 2019 ESC/EAS recommended low-density lipoprotein cholesterol (LDL-C) goals. Whether the treatment landscape has evolved, or gaps persist remains of interest. Methods Baseline data are presented from SANTORINI, an observational, prospective study that documents the use of lipid-lowering therapies (LLTs) in patients ≥18 years at high or very high CV risk between 2020 and 2021 across primary and secondary care settings in 14 European countries. Findings Of 9602 enrolled patients, 9044 with complete data were included (mean age: 65.3 ± 10.9 years; 72.6% male). Physicians reported using 2019 ESC/EAS guidelines as a basis for CV risk classification in 52.0% (4706/9044) of patients (overall: high risk 29.2%; very high risk 70.8%). However, centrally re-assessed CV risk based on 2019 ESC/EAS guidelines suggested 6.5% (308/4706) and 91.0% (4284/4706) were high- and very high-risk patients, respectively. Overall, 21.8% of patients had no documented LLTs, 54.2% were receiving monotherapy and 24.0% combination LLT. Median (interquartile range [IQR]) LDL-C was 2.1 (1.6, 3.0) mmol/L (82 [60, 117] mg/dL), with 20.1% of patients achieving risk-based LDL-C goals as per the 2019 ESC/EAS guidelines. Interpretation At the time of study enrolment, 80% of high- and very high-risk patients failed to achieve 2019 ESC/EAS guidelines LDL-C goals. Contributory factors may include CV risk underestimation and underutilization of combination therapies. Further efforts are needed to achieve current guideline-recommended LDL-C goals. Trial registration ClinicalTrials.gov Identifier: NCT04271280. Funding This study is funded by Daiichi Sankyo Europe GmbH, Munich, Germany.
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Affiliation(s)
- Kausik K. Ray
- Imperial Centre for Cardiovascular Disease Prevention, ICTU-Global, Imperial College London, London, UK
- Corresponding author. Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, Level 2, Faculty Building, South Kensington Campus, London SW7 2AZ, UK.
| | - Inaam Haq
- Medical Affairs, Daiichi Sankyo Europe, Munich, Germany
| | - Aikaterini Bilitou
- Health Economics and Outcomes Research, Daiichi Sankyo Europe, Munich, Germany
| | | | - Annie Burden
- Biostatistics and Data Management, Daiichi Sankyo Europe, Munich, Germany
| | - Carlos Aguiar
- Advanced Heart Failure and Heart Transplantation Unit, Heart Institute, Carnaxide, Portugal
| | - Marcello Arca
- Department of Translational and Precision Medicine, Sapienza Università di Roma, Rome, Italy
| | - Derek L. Connolly
- Sandwell and West Birmingham NHS Trust, Birmingham City Hospital, Institute of Cardiovascular Sciences, University of Birmingham, and Aston Medical School, Birmingham, UK
| | - Mats Eriksson
- Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jean Ferrières
- Department of Cardiology and INSERM UMR 1295, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Ulrich Laufs
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Jose M. Mostaza
- Department of Internal Medicine, La Paz-Carlos III Hospital, Madrid, Spain
| | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Ernst Rietzschel
- Department of Internal Medicine and Pediatrics, Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Timo Strandberg
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Hermann Toplak
- Division of Endocrinology and Diabetology, Department of Medicine, Medical University of Graz, Graz, Austria
| | - Frank L.J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alberico L. Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- Multimedica IRCCS, Milan, Italy
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12
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Fernández MS, Silva Melchor L, Martínez-Sellés M, Viana Tejedor A, Aguilar R, Lopez de Sa Areses E, Martín Asenjo R. Early approach to LDL-related risk after acute coronary syndrome: The OPTA Project. Expert Rev Cardiovasc Ther 2023:1-6. [PMID: 37144281 DOI: 10.1080/14779072.2023.2211266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Hyperlipidemia is the main underlying cause of atherosclerotic cardiovascular disease. Reducing low-density lipoprotein (LDL) cholesterol to recommended targets after an acute coronary syndrome (ACS) is of utmost importance as it is associated with a reduction of mortality and further cardiovascular events. Unfortunately, there are considerable gaps between guideline recommendations and clinical practice. In addition, the approach to treatment of this population is very heterogeneous, even in specialized cardiovascular units. Some easy-to-implement strategies may help to optimize the management of these patients. AREAS COVERED The OPTA Project was developed to identify these gaps and to provide recommendations to improve and harmonize the management of patients with ACS, with a specific focus on lipids. EXPERT OPINION Five areas of interest were defined: 1) evaluation of cardiovascular risk at admission, 2) development of a strategy to effectively and rapidly reduce LDL cholesterol levels, 3) determining LDL cholesterol goals (<55 mg/dL or stricter) and follow-up, 4) data collection during hospitalization, and 5) standardized discharge report. Specific recommendations are given to reduce inequalities, following the targets "the lower, the better" and "the earlier, the better".
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Affiliation(s)
| | - Lorenzo Silva Melchor
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda-Madrid, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañon, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Ana Viana Tejedor
- Department of Cardiology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Rio Aguilar
- Department of Cardiology. Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, Spain
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13
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Barrios V, Pintó X, Escobar C, Varona JF, Gámez JM. Real-World Attainment of Low-Density Lipoprotein Cholesterol Goals in Patients at High Risk of Cardiovascular Disease Treated with High-Intensity Statins: The TERESA Study. J Clin Med 2023; 12:3187. [PMID: 37176627 PMCID: PMC10179558 DOI: 10.3390/jcm12093187] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Despite steady improvements in cardiovascular disease (CVD) prevention, a scarce proportion of patients achieve the recommended LDL-C goals, even under high-intensity lipid-lowering therapy (LLT). Our study aimed to evaluate the attainment rate of LDL-C targets recommended by the 2019 European guidelines, and to characterize potential factors associated with LDL-C goal achievement and change patterns in LLT. We conducted a retrospective, observational study on patients treated with high-intensity atorvastatin or rosuvastatin ± ezetimibe at cardiology and internal medicine clinics across Spain. It included 1570 evaluable patients (median age: 62 years; established CVD: 77.5% [myocardial infarction: 34.3%]; and 85.8% at very high cardiovascular risk). Rosuvastatin ± ezetimibe was the LLT in 52.2% of patients, and atorvastatin ± ezetimibe in 47.8%. LLT had been modified in 36.8% of patients (side effects: 10%), being the most common switch from atorvastatin- to rosuvastatin-based treatment (77.2%). The risk-based LDL-C goal attainment rate was 31.1%, with 78.2% high-risk and 71.7% very high-risk patients not achieving the recommended LDL-C targets. Established CVD and familial hypercholesterolemia were significantly associated with the non-achievement of LDL-C goals. Although having limitations, this study shows that the guideline-recommended LDL-C goal attainment rate is still suboptimal despite using high-intensity statin therapy in a real-world setting in Spain.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, University Hospital Ramón y Cajal, Alcalá University, 28034 Madrid, Spain
| | - Xavier Pintó
- Lipid and Vascular Risk Unit, Department of Internal Medicine, University Hospital of Bellvitge-Idibell-UB-CiberObn, 08907 L’Hospitalet de Llobregat, Spain;
| | - Carlos Escobar
- Department of Cardiology, University Hospital La Paz, 28046 Madrid, Spain;
| | - Jose F. Varona
- Department of Internal Medicine, University Hospital HM Monteprincipe, HM Hospitales, 28660 Madrid, Spain;
| | - José M. Gámez
- Department of Cardiology, University Hospital Son Llàtzer, 07198 Palma, Spain;
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN CB 12/03/30038), Instituto de Salud Carlos III, 28029 Madrid, Spain
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14
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Pallarés-Carratalá V, Barrios V, Fierro-González D, Polo-García J, Cinza-Sanjurjo S. Cardiovascular Risk in Patients with Dyslipidemia and Their Degree of Control as Perceived by Primary Care Physicians in a Survey-TERESA-Opinion Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2388. [PMID: 36767754 PMCID: PMC9915170 DOI: 10.3390/ijerph20032388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate, through a survey, the opinion of primary care (PC) physicians on the magnitude of dyslipidemia and its degree of control in their clinical practice. MATERIALS AND METHODS An ecological study was carried out, in which the physicians were invited to participate by means of an online letter. Data were collected at a single timepoint and were based only on the experience, knowledge, and routine clinical practice of the participating physician. RESULTS A total of 300 physicians answered the questionnaire and estimated the prevalence of dyslipidemia between 2% and 80%. They estimated that 23.5% of their patients were high-risk, 18.2% were very high-risk, and 14.4% had recurrent events in the last 2 years. The PC physicians considered that 61.5% of their patients achieved the targets set. The participants fixed the presence of side-effects to statins at 14%. The statin that was considered safest with regard to side-effects was rosuvastatin (69%). CONCLUSIONS PC physicians in Spain perceive that the CVR of their patients is high. This, together with the overestimation of the degree of control of LDL-C, could justify the inertia in the treatment of lipids. Moreover, they perceive that one-sixth of the patients treated with statins have side-effects.
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Affiliation(s)
- Vicente Pallarés-Carratalá
- Health Surveillance Unit, Unión de Mutuas, 12004 Castellón de la Plana, Spain
- Department of Medicine, Universitat Jaume I, 12071 Castellón de la Plana, Spain
| | - Vivencio Barrios
- Cardiology Department, H Ramón y Cajal, 28034 Madrid, Spain
- Department of Medicine, Alcala University, 28801 Madrid, Spain
| | | | | | - Sergio Cinza-Sanjurjo
- Milladoiro Health Centre, 15895 Santiago de Compostela, Spain
- Instituto de Investigación de Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
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Qureshi N, Antoniou S, Cornel JH, Schiele F, Perrone-Filardi P, Brachmann J, Sidelnikov E, Villa G, Ferguson S, Rowlands C, González-Juanatey JR. European Physician Survey Characterizing the Clinical Pathway and Treatment Patterns of Patients Post-Myocardial Infarction. Adv Ther 2023; 40:233-251. [PMID: 36289145 PMCID: PMC9859915 DOI: 10.1007/s12325-022-02344-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/29/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The 2019 European Society of Cardiology and European Atherosclerosis Society (2019 ESC/EAS) guidelines stress the importance of managing low-density lipoprotein cholesterol (LDL-C) after myocardial infarction (MI) to reduce the risk of cardiovascular events. Information on guideline implementation is limited. The aim of this survey was to describe current clinical practice regarding LDL-C management in the first year post-MI across Europe, improving understanding of the role of ESC/EAS guidelines on clinical practice. METHODS A qualitative web-based cross-sectional physician survey about the patient pathway and LDL-C management post-MI was conducted in 360 physicians from France, Italy, Germany, The Netherlands, Spain, and the UK (n = 60/country) between December 2019 and June 2020. Secondary and primary care physicians (SCPs/PCPs) described their experiences treating patients post-MI over the preceding 2 months. RESULTS Physicians reported that on average 90.7% of patients not prescribed lipid-lowering therapy (LLT) before an MI initiated LLT as inpatients; for patients already taking LLT, treatment was intensified for 64.7% of inpatients post-MI. SCPs reported prescribing higher-intensity statins and/or ezetimibe for between 72.3% (Italy) and 88.6% (UK) of patients post-MI. More than 80.0% of SCPs and 51.2% of PCPs stated that they would initiate a change in LLT immediately if patients did not achieve their LDL-C treatment goal by 12 weeks post-MI; 82.0% of SCPs and 55.1% of PCPs reported referring to 2019 ESC/EAS guidelines for management of patients post-MI. Barriers to initiating PCSK9 inhibitors (PCSK9is) included prior prescription of a maximally tolerated dose of statin (49.4%) and/or ezetimibe (38.9%), requirement to reach threshold LDL-C levels (44.9%), and pre-authorization requirements (30.4%). CONCLUSION Differences in clinical practice post-MI were reported across the countries surveyed, including divergence between 2019 ESC/EAS and local guidelines. Increased use of innovative medicines to achieve LDL-C goals should reduce risk of subsequent cardiovascular events in very high-risk patients post-MI.
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Affiliation(s)
| | | | - Jan H. Cornel
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Pasquale Perrone-Filardi
- Department of Advanced Biomedical Sciences, Federico II University and Mediterranea Cardiocentro, Naples, Italy
| | | | | | - Guillermo Villa
- Amgen (Europe) GmbH, Suurstoffi 22, 6343 Rotkreuz, Switzerland
| | | | | | - José R. González-Juanatey
- Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, CIBERCV, Santiago, Spain
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16
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Heintjes EM, Anastassopoulou A, Kuiper J, Bilitou A, Beest FJAPV, Herings RMC, Postma MJ, Jukema JW. Treatment and low-density lipoprotein cholesterol levels in patients with hypercholesterolaemia or mixed dyslipidaemia at high or very high cardiovascular risk: a population-based cross-sectional study in the Netherlands. Curr Med Res Opin 2023; 39:1-11. [PMID: 36168818 DOI: 10.1080/03007995.2022.2129228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To describe treatment patterns, low-density lipoprotein cholesterol (LDL-C) levels and healthcare resource utilization (HCRU) in the Netherlands in 2018 of patients with hypercholesterolaemia or mixed dyslipidaemia at high or very high cardiovascular (CV) risk. METHODS From the PHARMO Database Network adult patients with a diagnosis or receiving lipid lowering therapy (LLT) between 2009 and 2018 were selected. Patients at high or very high CV risk according to 2016 ESC/EAS guidelines with recorded LDL-C levels who were treated with LLT or were characterized as statin intolerant in 2018 were included. LLT treatment patterns, LDL-C levels and HCRU (General Practitioner [GP] consultations and hospitalizations) were assessed. RESULTS The study population included 54,346 patients, of which 70% were at very high CV risk and 30% at high CV risk. The majority (93%) received statin monotherapy, mostly of moderate (73%) or high (15%) intensity. Only 3% received a combination of statin and ezetimibe. Statin intolerance, based on a treatment algorithm, was estimated at 3%. Average LDL-C decreased with LLT intensity. Overall, 74% reached LDL-C < 2.5 mmol/l and 34% <1.8 mmol/l with their current treatment, and 46% reached their LDL-C goal according to 2016 ESC/EAS guidelines. The highest rates of hospitalizations and GP consultations, including home visits, were recorded in patients with peripheral artery disease or polyvascular disease. CONCLUSION The treatment of hypercholesterolaemia and mixed dyslipidaemia in patients at high or very high CV risk in the Netherlands was suboptimal in 2018. To further lower CV risk alternative treatment strategies using add-on therapies are needed.
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Affiliation(s)
- Edith M Heintjes
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | | | - Josephina Kuiper
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | | | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
- Pharmacoepidemiology & Health Care Optimization, Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC (Location VUmc), Amsterdam, the Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, Groningen, the Netherlands
- Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
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Barrios V, Escobar C. Which patients could benefit from the use of bempedoic acid in clinical practice? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:847-848. [PMID: 35662522 DOI: 10.1016/j.rec.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
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18
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Ferhatbegović L, Mršić D, Kušljugić S, Pojskić B. LDL-C: The Only Causal Risk Factor for ASCVD. Why Is It Still Overlooked and Underestimated? Curr Atheroscler Rep 2022; 24:635-642. [PMID: 35635632 DOI: 10.1007/s11883-022-01037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Low-density lipoprotein cholesterol (LDL-C) is the most important causal risk factor for atherosclerotic cardiovascular disease (ASCVD). This article reviews why LDL-C remains overlooked and underestimated despite numerous studies that have proved its role. RECENT FINDINGS Recently published EAS/ESC Guidelines for dyslipidemia and EAS Guidelines for prevention set new targets for LDL-C levels in primary and secondary prevention of ASCVD. These guidelines are based on data from large studies and meta-analyzes that have shown that lower LDL-C also means lower cardiovascular event rates. Real-life experience published in registries worldwide has shown us that the guidelines have not been translated to everyday clinical practice, meaning that a significant number of patients are undertreated and have LDL-C levels well above target. Potential reasons for the abovementioned are poor adherence and education of the patient and physician and health care system related factors. Implementation of the latest version of guidelines will require continuous patient and physicians education, as well as a shared decision-making process between physician and patient.
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Affiliation(s)
- Lamija Ferhatbegović
- Department for Internal Diseases and Hemodialysis, Cantonal Hospital Zenica, 72 000, Zenica, Bosnia and Herzegovina.
| | - Denis Mršić
- Clinic for Internal Disease, University Clinical Center Tuzla, 75 000, Tuzla, Bosnia and Herzegovina
| | - Sabina Kušljugić
- Medical Faculty Tuzla, University Clinical Center Tuzla, 75 000, Tuzla, Bosnia and Herzegovina
| | - Belma Pojskić
- Department for Internal Diseases and Hemodialysis, Cantonal Hospital Zenica, 72 000, Zenica, Bosnia and Herzegovina
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19
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Barrios V, Escobar C. ¿Qué pacientes pueden beneficiarse del ácido bempedoico en la práctica clínica? Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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