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Treciokiene I, Daukintyte K, Hjemdahl P, Wettermark B. Trends in statin utilization and ischemic heart disease mortality in Lithuania and Sweden, 2000-2020. Ups J Med Sci 2024; 129:10412. [PMID: 38863727 PMCID: PMC11165250 DOI: 10.48101/ujms.v129.10412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/26/2024] [Accepted: 03/31/2024] [Indexed: 06/13/2024] Open
Abstract
Aims To compare statin utilization and ischemic heart disease (IHD) mortality trends in Lithuania and Sweden and to assess correlations between the total utilization of statins and IHD mortality. Methods An ecological study assessing time trends in statin utilization (DDDs per 1000 inhabitants per day; DDD/TID) and IHD mortality in Lithuania and Sweden between 2000 and 2020. Statin utilization data in Lithuania were wholesale trade data, and Swedish data were drugs dispensed at pharmacies. IHD mortality data were extracted from national databases as rates per 100 000 inhabitants. Associations between statin utilization and IHD mortality in Lithuania and Sweden were examined using Spearman's rank and Pearson's correlation coefficients, respectively. Results Statin utilization increased from 16.8 to 135.8 DDD/TID in Sweden and from 0.2 to 61.8 DDD/TID in Lithuania between 2000 and 2020. Medium intensity was the most common statin dosage in Lithuania, while Sweden used more high intensity than moderate-intensity statins from 2017. IHD mortality in Lithuania remained high between 2000 and 2020 (from 359.1 to 508.8 deaths per 100 000 population), while it decreased markedly in Sweden (from 226.87 to 88.7 deaths per 100 000 population). IHD mortality and statin utilization were inversely correlated in Sweden (r = -0.993, P < 0.001), while a positive correlation was found in Lithuania (rs = 0.871, P < 0.001). Conclusion Despite the growing statin utilization in both countries, Lithuania recorded a slight increase in IHD mortality rates unlike the situation in Sweden. This indicates room for improvement in the management of modifiable cardiovascular risk factors in Lithuania including how statins are prescribed and used in clinical practice.
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Affiliation(s)
- Indre Treciokiene
- Pharmacy and Pharmacology Centre, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kamile Daukintyte
- Pharmacy and Pharmacology Centre, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institute and Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wettermark
- Pharmacy and Pharmacology Centre, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
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2
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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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Tomida J, Yoshida T, Senda S, Sato T, Nakatsuma A, Iihara N. Statin persistence and adherence among older initiators: A nationwide cohort study using the national health insurance claims database in Japan. Pharmacoepidemiol Drug Saf 2023; 32:873-885. [PMID: 36960485 DOI: 10.1002/pds.5622] [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: 12/15/2022] [Revised: 02/28/2023] [Accepted: 03/19/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE This study clarifies the reality of persistence and adherence to statins in older Japanese people who initiated statin use and compares it between primary and secondary prevention cohorts. METHODS The nationwide study using the national claims database targeted statin initiators aged ≥55 years from FY2014 to FY2017 in Japan. Persistence and adherence to statins were analyzed overall and according to subgroups based on sex, age stratum, and prevention cohorts. Permissible gap of median days that statins were supplied per prescription to an individual was employed. Persistence rates were estimated as Kaplan-Meier estimates. Poor adherence during persistence was evaluated and defined as <0.8 of the proportion of days covered. RESULTS Of 3 675 949 initiators, approximately 80% initiated statin use with strong variants. The persistence rate at 1 year was 0.61. Poor adherence to statins during persistence was 8.0% in all patients and this value gradually improved with increasing age. Persistence rate and adherence were lower for the primary prevention cohort than for the secondary prevention cohort, and a notable sex difference was observed for the secondary prevention cohort, which was lower in females but was almost never and slightly observed in the primary prevention cohorts without and with high-risk factors, respectively. CONCLUSIONS Many statin initiators discontinued statins shortly following statin initiation but adherence while on statin therapy was good. Attentively watching older patients not to discontinue statins and listening to their reasons for discontinuation are required, especially for initiators in primary prevention and females in secondary prevention.
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Affiliation(s)
- Junko Tomida
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
| | - Tomoji Yoshida
- Faculty of Health and Welfare, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
| | - Shoichi Senda
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
| | - Tsugumichi Sato
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
- Faculty of Pharmaceutical Sciences, Tokyo University of Science, 2641 Yamazaki, Noda-City, Chiba, 278-8510, Japan
| | - Akira Nakatsuma
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
| | - Naomi Iihara
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki, Kagawa, 769-2193, Japan
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Mahmoud MA, Meyer JC, Awaisu A, Fadare J, Fathelrahman AI, Saleem F, Aljadhey H, Godman B. Editorial: Medication safety and interventions to reduce patient harm in low- and middle-income countries. Front Pharmacol 2023; 13:1124371. [PMID: 36699062 PMCID: PMC9868153 DOI: 10.3389/fphar.2022.1124371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Mansour Adam Mahmoud
- Department of Clinical and Hospital Pharmacy, Taibah University, Medina, Saudi Arabia
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa,South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa,*Correspondence: Johanna C. Meyer,
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado Ekiti, Nigeria,Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria
| | | | | | | | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa,Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates,Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
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5
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Doganer YC, Aydogan U, Kaplan U, Gormel S, Rohrer JE, Yuksel UC. Statin adherence in patients with high cardiovascular risk: a cross-sectional study. Postgrad Med 2022; 135:361-369. [PMID: 36345979 DOI: 10.1080/00325481.2022.2144030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Statin adherence is an essential problem although lifetime medication is recommended especially in patients with high cardiovascular risk. The importance of perceived risk as a predictor of adherence among cardiology patients has not been fully explored. This study aimed to test the importance of perceived risk as a predictor of statin adherence amongst hypercholesterolemic patients to identify predictors associated with poor adherence. METHODS This cross-sectional study was conducted at cardiology outpatient clinics of the University hospital in Ankara, Turkey. A total of 327 consecutive patients with high CV risk were recruited. Self-reported Morisky Green Levine Medication Adherence Scale was used to assess statin adherence. RESULTS Of the patients studied, 34.5% had concerns about side effects. Also, the mean age was 63.85 ± 11.29 years, 66.1% were men, 32.4% applied non-drug alternative therapies, 53.2% had a Mediterranean-style diet and 20.8% checked their lipid values irregularly. Participants reported 50.2% high, 30% moderate, and 19.9% low statin medication adherence. Low-density lipoprotein cholesterol (LDL-C), Total Cholesterol (TC), Triglyceride (TG) and high-density lipoprotein (HDL) control rates were 44.6%, 74.3%, 61.5% and 41.6%. On multiple logistic regression, concern about side effects was associated with a statistically significant quadruple elevation of odds of non-adherence. Also, being male, former smokers, not having complementary interventions, having regular visits, being educated for more than 5 years, having low depressive symptom scores, living in a rural, being never or former smokers, employee were significant predictors of high medication adherence scores. CONCLUSION Approximately half of the patients reported high medication adherence. Proper strategies to improve adherence would include patient education efforts focused on patients with concerns about side effects and those who are female, less educated, current smokers, interested in complementary interventions, have irregular follow-up visits, and have depressive symptoms. Brief medication adherence scales may facilitate the assessment of patients' adherence.
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Affiliation(s)
- Yusuf Cetin Doganer
- Department of Family Medicine, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey
| | - Umit Aydogan
- Department of Family Medicine, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey
| | - Umit Kaplan
- Ministry of National Defence, Ankara, Turkey
| | - Suat Gormel
- Department of Cardiology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | | | - Uygar Cagdas Yuksel
- Department of Cardiology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
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6
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Nakagawa C, Yokoyama S, Hosomi K. Association of Statin Adherence With the Development of Nonalcoholic Fatty Liver Disease: A Nested Case-Control Study Using a Japanese Claims Database. Ann Pharmacother 2022; 57:637-645. [PMID: 36168669 DOI: 10.1177/10600280221126971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Statins are expected to have beneficial effects on nonalcoholic fatty liver disease (NAFLD); however, evidence remains insufficient. OBJECTIVE In this study, we aim to investigate the association between statin adherence and NAFLD development. METHODS We conducted a nested case-control study of statin users using the Japan Medical Data Center administrative claims database (January 2005 to January 2020). Individuals who developed NAFLD were designated as cases. For each case, we randomly selected a maximum of 10 controls using risk set sampling. Good adherence was defined as the proportion of days covered (PDC) of ≥0.80. Higher intensity was defined as the median or higher of a cumulative defined daily dose (cDDD) per day covered by statin prescription. Conditional logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS In this study, 253 383 patients with the first statin prescription were identified. Of them, 7080 were selected and matched to 70 734 controls. The medians of PDC and intensity were 0.88 (interquartile range [IQR], 0.61-0.96) and 0.32 (IQR, 0.25-0.50) cDDD/day, respectively. Good adherence was significantly associated with a reduced risk of NAFLD development (adjusted OR, 0.82; 95% CI, 0.78-0.86). Higher intensity was not significantly associated with a reduced risk of NAFLD development (adjusted OR, 1.02; 95% CI, 0.97-1.08). CONCLUSION AND RELEVANCE Good adherence to statins is associated with a reduced risk of NAFLD development, regardless of the statin intensity. Appropriate statin therapy could reduce the risk of NAFLD development.
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Affiliation(s)
- Chihiro Nakagawa
- Division of Drug Informatics, School of Pharmacy, Kindai University, Osaka, Japan
| | - Satoshi Yokoyama
- Division of Drug Informatics, School of Pharmacy, Kindai University, Osaka, Japan
| | - Kouichi Hosomi
- Division of Drug Informatics, School of Pharmacy, Kindai University, Osaka, Japan
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7
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Mazhar F, Hjemdahl P, Clase CM, Johnell K, Jernberg T, Carrero JJ. Lipid-lowering treatment intensity, persistence, adherence and goal attainment in patients with coronary heart disease. Am Heart J 2022; 251:78-90. [PMID: 35654163 DOI: 10.1016/j.ahj.2022.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND To examine patterns of lipid-lowering therapy (LLT) use, and persistence and adherence among patients with coronary heart disease and their associations with lipoprotein cholesterol (LDL-C) goal attainment. METHODS Observational study among 26,768 patients who had suffered a myocardial infarction or had been revascularized in Stockholm during 2012 to 2018, and followed up through 2019. Outcomes included initiation of LLT, discontinuation, re-initiation, adherence to treatment and LDL-C goal attainment according to the European dyslipidaemia guidelines from 2011 and 2016 (mainly LDL-C <1.8 mmol/L). RESULTS 82% of patients commenced or continued LLT within 90 days after discharge. Of those, 71% were dispensed an LLT prescription within 30 days (62% of them for high-intensity LLT). High-intensity LLT prescribing increased over time, from 12% in 2012 to 78% in 2018. During a median follow-up of 3 (IQR 2-5) years 73% continued to fill prescriptions for a statin, 26.3% temporarily or permanently discontinued, and 0.5% changed to non-statin LLT. Only 1.3% discontinued statin treatment permanently. Throughout observation, about 80% of patients showed good statin adherence (proportion of days covered ≥80%). LDL-C target attainment was 52% the first year and <50% during subsequent years. LDL-C goal attainment was highest among patients receiving high-intensity statin treatment and showing good treatment adherence. CONCLUSION In secondary prevention for patients with established coronary heart disease, the proportion of LDL-C target attainment was low throughout the time period of the study, despite increasing use of high-intensity LLT and good treatment persistence and adherence.
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Affiliation(s)
- Faizan Mazhar
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institute and Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Catherine M Clase
- Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital (T.J.), Karolinska Institute, Stockholm, Sweden
| | - Juan Jesus Carrero
- Department of Clinical Sciences, Danderyd University Hospital (T.J.), Karolinska Institute, Stockholm, Sweden
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8
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Alam U, Al-Bazz DY, Soran H. Bempedoic Acid: The New Kid on the Block for the Treatment of Dyslipidemia and LDL Cholesterol: A Narrative Review. Diabetes Ther 2021; 12:1779-1789. [PMID: 34037950 PMCID: PMC8266948 DOI: 10.1007/s13300-021-01070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
Abstract
Diabetes is a major risk factor for atherosclerotic cardiovascular disease (ASCVD) in which dyslipidaemia plays a crucial role. Statins are first line therapy for primary and secondary prevention of ASCVD; however, adverse events include reversible musculoskeletal and liver side effects in addition to a diabetogenic association. In this short review, we provide a succinct narrative of the future role and current trial data of a novel first-in-class molecule, bempedoic acid. The authors provide their expert insight with a focus on Phase III randomised controlled trials (RCT) of bempedoic acid. Bempedoic acid was approved by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) in February and March 2020, respectively, and is a novel molecule which inhibits cholesterol biosynthesis in the same mechanistic pathway as statins. It is a first-in-class small molecule, delivered as a prodrug and administered as an oral, once-daily dose that decreases low-density lipoprotein cholesterol (LDL-C) levels. Phase II and III RCTs have demonstrated efficacy with adequate safety data as mono- or combination therapy with statins and ezetimibe. Bempedoic acid is hepatically converted to the active drug with a lack of activation in skeletal muscle. Due to this novel mechanism, musculoskeletal-related adverse events exhibit a lower prevalence providing an alternative pharmacotherapy in statin-intolerant patients. Bempedoic acid may be used as an adjunct to diet and maximally tolerated statin therapy or in statin-intolerant patients for the treatment of dyslipidaemia. The recent National Institute of Health and Care Excellence (NICE) (UK) technology appraisal guidance [TA694] published in April 2021 recommended bempedoic acid with ezetimibe as a treatment option for primary hypercholesterolaemia or mixed dyslipidaemia if statins are not tolerated or contraindicated and if there is inadequate control of LDL-C with ezetimibe alone. Additionally, outcomes trials evaluating 'hard' endpoints in statin-intolerant patients or those with ASCVD are currently underway.
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Affiliation(s)
- Uazman Alam
- Department of Cardiovascular and Metabolic Medicine and the Pain Research Institute, Clinical Sciences Centre, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Foundation Trust, Liverpool, L9 7AL, UK.
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester, Manchester, UK.
| | - Dalal Y Al-Bazz
- Department of Cardiovascular and Metabolic Medicine and the Pain Research Institute, Clinical Sciences Centre, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool University Hospital NHS Foundation Trust, Liverpool, L9 7AL, UK
| | - Handrean Soran
- Institute of Cardiovascular Sciences, University of Manchester and Manchester Foundation Trust, Manchester, M13 9WL, UK.
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Machado-Duque ME, Gaviria-Mendoza A, Machado-Alba JE. Real-World Effectiveness of Therapy With Rosuvastatin Combined With Fenofibric Acid in a Sample of Colombian Patients With Mixed Dyslipidemia. J Prim Care Community Health 2020; 11:2150132720977733. [PMID: 33251941 PMCID: PMC7705806 DOI: 10.1177/2150132720977733] [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] [Indexed: 11/29/2022] Open
Abstract
Background Ischemic heart disease is the leading cause of death in the world and is associated with dyslipidemia, high blood pressure, diabetes mellitus, and other factors. Objective To determine the clinical effectiveness on the lipid profile of the rosuvastatin + fenofibric acid combination in Colombian patients with high cardiovascular risk and mixed dyslipidemia. Methods Longitudinal observational study in a random sample of patients with a diagnosis of mixed dyslipidemia and moderate, high, or very high cardiovascular risk who were treated with rosuvastatin + fenofibric acid. Anthropometric, clinical, laboratory, comorbidity, and pharmacological variables were identified. Effectiveness on the lipid profile was determined. Results A total of 386 patients were analyzed. They had a mean age of 60.8 ± 11.4 years, 53.1% were female, and 75.6% had high/very high cardiovascular risk. The initial evaluation showed a mean LDL cholesterol of 138.4 ± 67.1 mg/dL and triglycerides of 679.7 ± 573.6 mg/dL. At the end of follow-up, mean LDL cholesterol was 87.5 ± 41.2 mg/dL (reduced by 43.3%; P < .001), and triglycerides were 243.5 ± 170.5 mg/dL (reduced by 64.2%; P < .001). Only 35.4% (n = 73) of patients with very high risk reached the goal of metabolic control, compared to 61.6% (n = 53) with high risk and 55.4% (n = 46) with moderate risk. Belonging to the very high-risk group was associated with a lower probability of achieving the control goal (OR: 0.32; 95%CI: 0.192-0.539). Conclusion The combination of rosuvastatin + fenofibric acid is an effective option in patients with mixed dyslipidemia and high cardiovascular risk, providing a therapeutic alternative for those conditions that require it.
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Affiliation(s)
- Manuel E Machado-Duque
- Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.,Grupo Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Andrés Gaviria-Mendoza
- Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.,Grupo Biomedicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
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Why might visit-to visit variability of lipoproteins have an effect on cardiovascular events? Atherosclerosis 2020; 312:99-100. [DOI: 10.1016/j.atherosclerosis.2020.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/30/2020] [Indexed: 02/06/2023]
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de Souza Groia Veloso RC, Cruzeiro MGM, Dias BM, Reis AMM. Profile of use and access to statins in patients with coronary arterial disease in an outpatient clinic of a teaching hospital. Curr Med Res Opin 2020; 36:1427-1431. [PMID: 32634034 DOI: 10.1080/03007995.2020.1793313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of the study is to describe statin use pattern and access among individuals with coronary artery disease of a secondary care service of the Brazilian Unified Health System. METHODS This is a cross-sectional study carried out in a multi-professional outpatient cardiology clinic at a public, university, and general hospital in the state of Minas Gerais, Brazil. The level of adherence to the recommendations of intensity of the statin therapy of Brazilian and American dyslipidemia guidelines was established. The prescribed statin, adherence to treatment, access, and clinically relevant drug interactions with statins were identified. Access to statin was analyzed through the availability and acquisition capacity realms. RESULTS The sample consisted of 148 patients who were selected from April 2018 to February 2019. Approximately 90% of patients were under 75 years old. The most prevalent cardiovascular diagnoses were acute myocardial infarction with ST-segment elevation and without ST-segment elevation. All patients had a very high cardiovascular risk. Polypharmacy and cardiovascular polypharmacy were identified in 91.2% and 74.3% of patients, respectively. We identified that 90.6% of the patients used a moderate-intensity statin, and simvastatin was the most common stain used. The level of adherence to the recommendations of Brazilian and American dyslipidemia guidelines for statin use was 9.4% and 21.6%, respectively. Total free access to statins by the Unified Health System was 44.6%, with 52.1% of respondents reporting that they received statins at the health center, 25.7% through the popular pharmacy program via copayment, and 33.8% from a private pharmacy. CONCLUSION The level of adherence to the recommendations of U.S. and Brazilian guidelines of dyslipidemia for statin use was low. Most patients used a moderate intensity statin, despite having a high cardiovascular risk. Simvastatin was the most prescribed statin.
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Affiliation(s)
- Ronara Camila de Souza Groia Veloso
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Minas Gerais, Brasil
| | | | - Bianca Menezes Dias
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Minas Gerais, Brasil
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Rezende Macedo do Nascimento RC, Mueller T, Godman B, MacBride Stewart S, Hurding S, de Assis Acurcio F, Guerra Junior AA, Alvares Teodoro J, Morton A, Bennie M, Kurdi A. Real-world evaluation of the impact of statin intensity on adherence and persistence to therapy: A Scottish population-based study. Br J Clin Pharmacol 2020; 86:2349-2361. [PMID: 32353163 PMCID: PMC7688536 DOI: 10.1111/bcp.14333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/31/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022] Open
Abstract
Aim To assess associations between statin intensity and adherence, persistence and discontinuation of statin therapy in Scotland. Method Retrospective cohort study, using linked electronic health records covering a period from January 2009 to December 2016. The study cohort included adult patients (≥18 years) newly initiating statins within Greater Glasgow and Clyde, Scotland. Study outcomes comprised adherence, discontinuation and persistence to treatment, stratified by three exposure groups (high, moderate and low intensity). Discontinuation and persistence were calculated using the refill‐gap and anniversary methods, respectively. Proportion of days covered (PDC) was used as a proxy for adherence. Kaplan‐Meier survival curves and Cox proportional hazard models were used to evaluate discontinuation, and associations between adherence/persistence and statin intensity were assessed using logistic regression. Results A total of 73 716 patients with a mean age of 61.4 ± 12.6 years were included; the majority (88.3%) received moderate intensity statins. Discontinuation rates differed between intensity levels, with high‐intensity patients less likely to discontinue treatment compared to those on moderate intensity (prior cardiovascular disease [CVD]: HR 0.43 [95% CI 0.34‐0.55]; no prior CVD: 0.80 [0.74‐0.86]). Persistence declined over time, and high‐intensity patients had the highest persistence rates. Overall, 52.6% of patients were adherent to treatment (PDC ≥ 80%), but adherence was considerably higher among high‐intensity patients (63.7%). Conclusion High‐intensity statins were associated with better persistence and adherence to treatment, but overall long‐term persistence and adherence remain a challenge, particularly among patients without prior CVD. This needs addressing.
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Affiliation(s)
| | - Tanja Mueller
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Simon Hurding
- Directorate for Health Finance, The Scottish Government, Edinburgh, UK
| | - Francisco de Assis Acurcio
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Augusto Afonso Guerra Junior
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares Teodoro
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, School of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alec Morton
- Strathclyde Business School, University of Strathclyde, Glasgow, UK
| | - Marion Bennie
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Edinburgh, UK
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
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Godman B. Ongoing initiatives to improve the prescribing of medicines across sectors and the implications. ADVANCES IN HUMAN BIOLOGY 2020. [DOI: 10.4103/aihb.aihb_90_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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