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Huo Y, Lesogor A, Lee CW, Chiang CE, Mena-Madrazo J, Poh KK, Jeong MH, Maheux P, Zhang M, Wei S, Han Y, Li Y. Efficacy and Safety of Inclisiran in Asian Patients: Results From ORION-18. JACC. ASIA 2024; 4:123-134. [PMID: 38371290 PMCID: PMC10866732 DOI: 10.1016/j.jacasi.2023.09.006] [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: 06/06/2023] [Revised: 08/22/2023] [Accepted: 09/11/2023] [Indexed: 02/20/2024]
Abstract
Background Management of low-density lipoprotein cholesterol (LDL-C) in Asia remains suboptimal, with ∼50% of patients who are treated with lipid-lowering therapies (LLTs) unable to achieve their guideline-recommended LDL-C goals. Asian-representative studies of the use of inclisiran are needed. Objectives The authors sought to evaluate the efficacy and safety of inclisiran in Asian patients with atherosclerotic cardiovascular disease (ASCVD) or high risk of ASCVD, as an adjunct to diet and maximally tolerated statin dose, with or without additional LLTs. Methods The ORION-18 was a phase 3 double-blind trial in which patients were randomized 1:1 to receive either 300 mg inclisiran sodium or matching placebo on days 1, 90, and 270. Percentage change in LDL-C from baseline to day 330 was the primary endpoint. Results A total of 345 patients (mean age 59.5 years, mean baseline LDL-C 109 mg/dL, 74.7% male) were randomized to inclisiran or placebo. Baseline characteristics were similar in both groups. The percentage decrease in LDL-C from baseline to day 330 was 57.2% (P < 0.001); proprotein convertase subtilisin/kexin type 9 was reduced by 78.3% (P < 0.001). Time-adjusted percentage reduction in LDL-C from baseline after day 90 and up to day 360 was 56.3%. At day 330, 71.7% of participants with inclisiran achieved ≥50% reduction in LDL-C compared with 1.5% with placebo. Over the study period, total cholesterol, apolipoprotein B, and non-high-density lipoprotein cholesterol (HDL-C) levels were decreased significantly, and HDL-C levels increased. The incidence of adverse events with inclisiran was similar to that with placebo. Conclusions In Asian patients with ASCVD or high risk of ASCVD, inclisiran was effective and safe. (Study of Efficacy and Safety of Inclisiran in Asian Participants With Atherosclerotic Cardiovascular Disease [ASCVD] or ASCVD High Risk and Elevated Low-Density Lipoprotein Cholesterol [LDL-C] [ORION-18]; NCT04765657).
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Affiliation(s)
- Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | | | | | - Chern-En Chiang
- General Clinical Research Center and Division of Cardiology, Taipei Veterans General Hospital and Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | | | - Mengli Zhang
- China Novartis Institutes for Biomedical Research Co., Shanghai, China
| | | | - Yajun Han
- Mongolia People’s Hospital, Hohhot, China
| | - Yong Li
- Fudan University Hua Shan Hospital, Shanghai, China
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Lim HM, Ng CJ, Abdullah A, Danee M, Raubenheimer J, Dunn AG. Online health information behaviour and its association with statin adherence in patients with high cardiovascular risk: A prospective cohort study. Digit Health 2024; 10:20552076241241250. [PMID: 38515614 PMCID: PMC10956144 DOI: 10.1177/20552076241241250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 03/23/2024] Open
Abstract
Objective Statins are effective for preventing cardiovascular disease. However, many patients decide not to take statins because of negative influences, such as online misinformation. Online health information may affect decisions on medication adherence, but measuring it is challenging. This study aimed to examine the associations between online health information behaviour and statin adherence in patients with high cardiovascular risk. Methods A prospective cohort study involving 233 patients with high cardiovascular risk was conducted at a primary care clinic in Malaysia. Participants used a digital information diary tool to record online health information they encountered for 2 months and completed a questionnaire about statin necessity, concerns and adherence at the end of the observation period. Data were analysed using structural equation modelling. Results The results showed that 55.8% (130 of 233 patients) encountered online health information. Patients who actively sought online health information (91 of 233 patients) had higher concerns about statin use (β = 0.323, p = 0.023). Participants with higher concern about statin use were also more likely to be non-adherent (β = -0.337, p < 0.001). Patients who actively sought online health information were more likely to have lower statin adherence, mediated by higher concerns about statin use (indirect effect, β = -0.109, p = 0.048). Conclusions Our results suggest that patients with higher levels of concern about statins may be actively seeking online information about statins, and their concerns might influence how they search, what they find, and the potential to encounter misinformation. Our study highlights the importance of addressing patients' concerns about medications to improve adherence.
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Affiliation(s)
- Hooi Min Lim
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Adina Abdullah
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mahmoud Danee
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jacques Raubenheimer
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Adam G. Dunn
- Biomedical Informatics and Digital Health, Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia
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Undertreatment and Underachievement of LDL-C Target among Individuals with High and Very High Cardiovascular Risk in the Malaysian Community. Healthcare (Basel) 2022; 10:healthcare10122448. [PMID: 36553972 PMCID: PMC9777945 DOI: 10.3390/healthcare10122448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Dyslipidaemia is a major cause of morbidity and mortality. The aims of this study are to determine the prevalence of dyslipidaemia subtypes, the proportions of lipid-lowering therapy (LLT) use, and the achievement of low-density lipoprotein cholesterol (LDL-C) treatment targets for high-risk (HR) and very high-risk (VHR) Malaysians. This cross-sectional study involves 5279 participants across 11 states in Malaysia. The data were obtained through a standardised questionnaire, anthropometric measurements, venous glucose and lipid profile. The participants with existing cardiovascular disease (CVD) or diabetes with at least one of the other major risk factors (smoking, hypertension or dyslipidaemia) were grouped into the VHR category. Other participants were risk-categorised using the Framingham General CVD Risk Score (FRS-CVD). The prevalence of elevated LDL-C, LLT use and LDL-C target were set according to respective risk categories. Pearson's chi-squared test was used to test the difference in the proportions. The mean ± standard deviation (SD) age was 41.1 ± 14.8 years, and 62.2% (3283/5279) of the group were females. Within the participant group, 51.5% were found to have elevated total cholesterol, 28.8% had low HDL-C, and 33.8% had high triglyceride. As for elevated LDL-C, 9.8% were in VHR, 8.6% in HR, 5.8% in MR and 34.9% in LR categories. Among the VHR group, 75.8% were not on LLT, and only 15.9% achieved the LDL-C target. As for the HR category, 87.7% were not on LLT, and only 16.1% achieved the LDL-C target. Dyslipidaemia is highly prevalent among Malaysians. The majority of VHR and HR participants were not on LLT and did not achieve LDL-C treatment targets. Proactive programs are warranted to combat dyslipidaemia-associated CVD events in these groups.
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Sex Difference in Control of Low-Density Lipoprotein Cholesterol in Older Patients after Acute Coronary Syndrome. Geriatrics (Basel) 2022; 7:geriatrics7040071. [PMID: 35893318 PMCID: PMC9326734 DOI: 10.3390/geriatrics7040071] [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: 05/17/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 12/03/2022] Open
Abstract
Objective. The main aim of this study is to examine the achievement of low-density lipoprotein cholesterol (LDL-C) targets in older patients after acute coronary syndrome (ACS), and the secondary aim is to examine sex difference in LDL-C target achievement. Methods. Patients aged ≥60 years with ACS admitted to a tertiary hospital in Vietnam were recruited from December 2019 to August 2020. LDL-C target achievement was defined as having an LDL-C goal of <1.8 mmol/L. Multivariate logistic regression was applied to investigate the predictive factors for LDL-C target achievement. Results. A total of 232 participants were included in this study (mean age 75.5 years, 40.1% were women). Participants had an average of three chronic conditions other than coronary heart disease. All participants were prescribed statin monotherapy at discharge (59.5% on high-intensity statins). After 3 months, 218 (94.0%) of the participants were on statin monotherapy, 14 (6.0%) were on statin combined with ezetimibe. The proportion of participants that achieved LDL-C target after 3 months was 56.5% (40.9% in women and 66.9% in men, p < 0.001). On univariate logistic regression, women were less likely to achieve their LDL-C target compared to men (unadjusted OR 0.34, 95% CI 0.20−0.59). This association was still significant in the adjusted model (adjusted OR 0.43, 95% CI 0.24−0.78). Other factors that were significantly associated with LDL-C target achievement included age, smoking, sedentary lifestyle, LDL-C level on admission, history of using statin before admission, and high-intensity statin prescribed at discharge. Conclusions. Our study found that nearly a half of older patients with ACS did not achieve their LDL-C target after 3 months, and suboptimal control of LDL-C was more common in women.
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Kim JB, Song WH, Park JS, Youn TJ, Park YH, Kim SJ, Ahn SG, Doh JH, Cho YH, Kim JW. A randomized, open-label, parallel, multi-center Phase IV study to compare the efficacy and safety of atorvastatin 10 and 20 mg in high-risk Asian patients with hypercholesterolemia. PLoS One 2021; 16:e0245481. [PMID: 33481866 PMCID: PMC7822387 DOI: 10.1371/journal.pone.0245481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Although accumulating evidence suggests a more extensive reduction of low-density lipoprotein cholesterol (LDL-C), it is unclear whether a higher statin dose is more effective and cost-effective in the Asian population. This study compared the efficacy, safety, and cost-effectiveness of atorvastatin 20 and 10 mg in high-risk Asian patients with hypercholesterolemia. Methods A 12-week, open-label, parallel, multicenter, Phase IV randomized controlled trial was conducted at ten hospitals in the Republic of Korea between October 2017 and May 2019. High-risk patients with hypercholesterolemia, defined according to 2015 Korean guidelines for dyslipidemia management, were eligible to participate. We randomly assigned 250 patients at risk of atherosclerotic cardiovascular disease to receive 20 mg (n = 124) or 10 mg (n = 126) of atorvastatin. The primary endpoint was the difference in the mean percentage change in LDL-C levels from baseline after 12 weeks. Cost-effectiveness was measured as an exploratory endpoint. Results LDL-C levels were reduced more significantly by atorvastatin 20 mg than by 10 mg after 12 weeks (42.4% vs. 33.5%, p < 0.0001). Significantly more patients achieved target LDL-C levels (<100 mg/dL for high-risk patients, <70 mg/dL for very high-risk patients) with atorvastatin 20 mg than with 10 mg (40.3% vs. 25.6%, p < 0.05). Apolipoprotein B decreased significantly with atorvastatin 20mg versus 10 mg (−36.2% vs. −29.9%, p < 0.05). Lipid ratios also showed greater improvement with atorvastatin 20 mg than with 10 mg (total cholesterol/high-density lipoprotein cholesterol ratio, −33.3% vs. −29.4%, p < 0.05; apolipoprotein B/apolipoprotein A1 ratio, −36.7% vs. −31.4%, p < 0.05). Atorvastatin 20 mg was more cost-effective than atorvastatin 10 mg in terms of both the average and incremental cost-effectiveness ratios. Safety and tolerability of atorvastatin 20 mg were comparable to those of atorvastatin 10 mg. Conclusion In high-risk Asian patients with hypercholesterolemia, atorvastatin 20 mg was both efficacious in reducing LDL-C and cost-effective compared with atorvastatin 10 mg.
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Affiliation(s)
- Ji Bak Kim
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Woo Hyuk Song
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jong Sung Park
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong Hyun Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Shin-Jae Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung Gyun Ahn
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Joon-Hyung Doh
- Department of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yun-Hyeong Cho
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Jin Won Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
- * E-mail:
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Lee J, Lee SH, Kim H, Lee SH, Cho JH, Lee H, Yim HW, Yoon KH, Kim HS, Kim JH. Low-density lipoprotein cholesterol reduction and target achievement after switching from statin monotherapy to statin/ezetimibe combination therapy: Real-world evidence. J Clin Pharm Ther 2020; 46:134-142. [PMID: 33026659 DOI: 10.1111/jcpt.13271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/16/2020] [Accepted: 09/05/2020] [Indexed: 01/11/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVES This study investigated the additional low-density lipoprotein cholesterol (LDL-C) reductions and target (LDL-C < 100 mg/dL) achievement rates in patients after switching from statin monotherapy to statin/ezetimibe combination therapy, in clinical practice. METHODS This retrospective study used data recovered from the electronic medical record systems of two tertiary care medical centres for patients treated between 2015 and 2017. Patients prescribed statin/ezetimibe combination therapy after switching from statin monotherapy were enrolled. The observed LDL-C reductions and the percentage of patients achieving LDL-C levels of <100 mg/dL, after 3 months of treatment, were assessed relative to baseline values. RESULTS AND DISCUSSION A total of 4252 patients with prescriptions for statin/ezetimibe combination therapy were enrolled. Changing from statin monotherapy to the combination therapy resulted in additional LDL-C level reductions of 31.0-41.0% (all intensity groups, P < .01). Similarly, 88.3-91.1% of the enrolled patients successfully achieved LDL-C levels of <100 mg/dL (all intensity groups, P < .01). A subgroup analysis of patients with baseline LDL-C levels ≥ 100 mg/dL showed that switching from moderate- or high-intensity statin monotherapy to a rosuvastatin/ezetimibe combination showed greater LDL-C reductions than did switching to an atorvastatin/ezetimibe combination, within the same statin intensity groups. WHAT IS NEW AND CONCLUSION The present study provides real-world evidence of the LDL-C reduction benefits associated with statin/ezetimibe combinations in the clinical practice setting. The results also demonstrate that if statin monotherapy does not effectively help patients reach their target LDL-C goals, changing to a statin/ezetimibe combination prescription may show enhanced LDL-C-lowering effects and improve the likelihood of achieving LDL-C targets, in real practice.
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Affiliation(s)
- Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sue Hyun Lee
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Korea
| | - Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Republic of Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hyoung Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunyong Lee
- Clinical Research Coordinating Center, Catholic Medical Center, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hun-Sung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Han Kim
- Division of Biomedical Informatics, Systems Biomedical Informatics Research Centre, Seoul National University College of Medicine, Seoul, Republic of Korea
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Li JJ, Liu HH, Wu NQ, Yeo KK, Tan K, Ako J, Krittayaphong R, Tan RS, Aylward PE, Baek SH, Dalal J, Fong AYY, Li YH, O'Brien RC, Lim TSE, Koh SYN, Scherer DJ, Tada H, Kang V, Butters J, Nicholls SJ. Statin intolerance: an updated, narrative review mainly focusing on muscle adverse effects. Expert Opin Drug Metab Toxicol 2020; 16:837-851. [PMID: 32729743 DOI: 10.1080/17425255.2020.1802426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Statins have been established as the standard of care for dyslipidemia and preventing cardiovascular diseases while posing few safety concerns. However, misconceptions about statin intolerance lead to their underuse, indicating a need to improve the understanding of the safety of this treatment. AREAS COVERED We searched PubMed and reviewed literatures related to statin intolerance published between February 2015 and February 2020. Important large-scale or landmark studies published before 2015 were also cited as key evidence. EXPERT OPINION Optimal lowering of low-density lipoprotein cholesterol with statins substantially reduces the risk of cardiovascular events. Muscle adverse events (AEs) were the most frequently reported AEs by statin users in clinical practice, but they usually occurred at a similar rate with statins and placebo in randomized controlled trials and had a spurious causal relationship with statin treatment. We proposed a rigorous definition for identifying true statin intolerance and present the criteria for defining different forms of muscle AEs and an algorithm for their management. True statin intolerance is uncommon, and every effort should be made to exclude false statin intolerance and ensure optimal use of statins. For the management of statin intolerance, statin-based approaches should be prioritized over non-statin approaches.
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Affiliation(s)
- Jian-Jun Li
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , 100037, Beijing, China
| | - Hui-Hui Liu
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , 100037, Beijing, China
| | - Na-Qiong Wu
- State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College , 100037, Beijing, China
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre and SingHealth Duke-NUS Cardiovascular Sciences , Singapore
| | - Kathryn Tan
- Department of Medicine, University of Hong Kong , Hong Kong, China
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University , Sagamihara, Japan
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University , Bangkok, Thailand
| | - Ru San Tan
- Department of Cardiology, National Heart Centre and SingHealth Duke-NUS Cardiovascular Sciences , Singapore
| | - Philip E Aylward
- South Australian Health and Medical Research Institute and Flinders University , Adelaide, Australia
| | - Sang Hong Baek
- Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul, Korea
| | - Jamshed Dalal
- Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital , Mumbai, India
| | - Alan Yean Yip Fong
- Department of Cardiology, Sarawak Heart Centre; and Clinical Research Centre, Sarawak General Hospital , Kuching, Malaysia
| | - Yi-Heng Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital , Tainan, Taiwan
| | - Richard C O'Brien
- Department of Endocrinology, Austin Health, University of Melbourne , Melbourne, Australia
| | - Tien Siang Eric Lim
- Department of Cardiology, National Heart Centre and SingHealth Duke-NUS Cardiovascular Sciences , Singapore
| | - Si Ya Natalie Koh
- Department of Cardiology, National Heart Centre and SingHealth Duke-NUS Cardiovascular Sciences , Singapore
| | - Daniel J Scherer
- South Australian Health and Medical Research Institute, University of Adelaide , Adelaide, South Australia, Australia
| | - Hayato Tada
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine , Kanazawa, Japan
| | | | - Julie Butters
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University , Melbourne, Australia
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University , Melbourne, Australia
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Achievement of the low-density lipoprotein cholesterol goal among patients with dyslipidemia in South Korea. PLoS One 2020; 15:e0228472. [PMID: 31999714 PMCID: PMC6992159 DOI: 10.1371/journal.pone.0228472] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is important to achieve the low-density lipoprotein cholesterol (LDL-C) goal recommended by clinical guidelines in managing the risk of cardiovascular (CV) events, however, the current management of LDL-C in actual clinical settings is suboptimal. We examined the LDL-C level among patients with dyslipidemia against the 2015 Korean guidelines, the crude rates of CV events based on LDL-C goal achievement, and the factors associated with LDL-C goal achievement. METHODS This was a retrospective cohort study using the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database from 2006 to 2013. Patients who had a health examination with LDL-C measurement between January 1, 2007, and December 31, 2011 were identified. Patients were required to have at least one diagnosis of dyslipidemia during the 1 year before the index date, defined as the first date of LDL-C measurement. The 2015 Korean guidelines were used to measure LDL-C goal achievement based on the CV risk level. Crude CV event rates were calculated for total and individual CV events as the number of events divided by person-years (PYs) during the follow-up period. CV events included acute coronary syndrome, ischemic stroke, peripheral artery disease, CV death, and all-cause death. Factors associated with LDL-C goal achievement were assessed using logistic regression. RESULTS In the NHIS-HEALS database, 69,942 patients met the eligibility criteria: 36.7%, 22.5%, 20.1%, and 20.6% were among the very high-, high-, moderate-, and low-risk groups for the CV events, respectively, as defined by the 2015 Korean guidelines. Approximately half of the patients with dyslipidemia (47.6%) achieved their recommended LDL-C goal, but the achievement rates were substantially different across CV risk levels (17.6%, 47.2%, 66.9%, and 82.4% for very high-, high-, moderate-, and low-risk groups, respectively; P<0.0001). The crude event rate of total CV events during the follow-up period in the LDL-C goal non-achievers was higher than that in the LDL-C goal achievers (24.35/100 PYs vs. 11.93/100 PYs; P<0.0001). LDL-C goal achievement was significantly associated with patient characteristics, including age, sex, body mass index, lipid-modifying therapy, and CV risk level. CONCLUSIONS In South Korea, LDL-C goal achievement among patients with very high or high CV risk was suboptimal. Patients who did not achieve the goal showed a higher rate of CV events during the follow-up period than patients who achieved the goal. LDL-C management strategies should be highlighted in dyslipidemia patients who are less likely to achieve the goal, such as female, overweight or obese patients, patients not adherent to statin, or patients with very high or high CV risk.
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Wang TD, Wang KL, Chiang CE. A Bridge Still Too Far. ACTA CARDIOLOGICA SINICA 2019; 35:615-617. [PMID: 31879513 PMCID: PMC6859108 DOI: 10.6515/acs.201911_35(6).20191028a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Tzung-Dau Wang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital
| | - Kang-Ling Wang
- General Clinical Research Center, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chern-En Chiang
- General Clinical Research Center, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Lee SH, Song WH, Jeong MH, Hur SH, Jeon DW, Jeung W, Gitt AK, Horack M, Vyas A, Lautsch D, Ambegaonkar B, Brudi P, Jang Y. Dyslipidemia and Rate of Under-Target Low-Density Lipoprotein-Cholesterol in Patients with Coronary Artery Disease in Korea. J Lipid Atheroscler 2019; 8:242-251. [PMID: 32821714 PMCID: PMC7379120 DOI: 10.12997/jla.2019.8.2.242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 12/17/2022] Open
Abstract
Objective The aim of this study was to evaluate under target rates of low-density lipoprotein-cholesterol (LDL-C) in Korean patients with stable coronary artery disease (CAD) or an acute coronary syndrome (ACS) in real world practice. Methods Dyslipidemia International Study II was an international observational study of patients with stable CAD or an ACS. Lipid profiles and use of lipid-lowering therapy (LLT) were documented at enrollment, and for the ACS cohort, 4 months follow-up was recommended. Rates of under target LDL-C as per European guidelines, were evaluated, and multivariate regression was performed to identify predictive factors of patients presenting under the target. Results A total of 808 patients were enrolled in Korea, 500 with stable CAD and 308 with ACS. Of these, 90.6% and 52.6% were being treated with LLT, respectively. In the stable CAD group, 40.0% were under target LDL-C, while in ACS group, the rate was 23.7%. A higher statin dose was independently associated with under target LDL-C in both groups (OR, 1.03; p=0.046 [stable CAD] and OR, 1.05; p=0.01 [ACS]). The mean statin dosage (atorvastatin equivalent) was 17 mg/day. In the 79 ACS patients who underwent the follow-up examination, the LDL-C under target rate rose to 59.5%. Conclusion Only a minority of patients with stable CAD or ACS were under their target LDL-C level at enrollment. The statin dose was not sufficient in the majority of patients. These results indicate a considerable LLT gap in Korean patients with established CAD.
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Affiliation(s)
- Sang-Hak Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Hyuk Song
- Cardiovascular Division, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seung-Ho Hur
- Department of Cardiology, Keimyung University Hospital, Daegu, Korea
| | - Dong Woon Jeon
- Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | | | - Anselm K Gitt
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.,Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
| | - Martin Horack
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Ami Vyas
- Department of Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | | | | | | | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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11
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The Taiwan Heart Registries: Its Influence on Cardiovascular Patient Care. J Am Coll Cardiol 2019; 71:1273-1283. [PMID: 29544612 DOI: 10.1016/j.jacc.2018.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 02/07/2023]
Abstract
Taiwanese heart registries for the main cardiovascular diseases have been conducted in the past 10 years, with the goal of examining the quality of cardiovascular patient care, which cannot be guaranteed by the universal Taiwan National Health Insurance. The results show suboptimal adherence to guideline recommendations. Door-to-balloon time and dual antiplatelet therapy use in acute coronary syndrome, standard medications for management of heart failure, low-density lipoprotein cholesterol levels in dyslipidemia, anticoagulant agent use in atrial fibrillation, and the understanding of sudden arrhythmia death syndrome were all found to be inadequate. However, all were improved, either by changing National Health Insurance policy or through continuous education for physicians and patients. Thus, specific cardiovascular disease registries could help examine the status of real-world practice, find inadequacies in guideline implementation and understanding of rare diseases, facilitate lobbying to policy makers and education for physicians and patients, and influence and improve cardiovascular patient care.
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12
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Chen Y, Yuan Z, Lu J, Eliaschewitz FG, Lorenzatti AJ, Monsalvo ML, Wang N, Hamer AW, Ge J. Randomized study of evolocumab in patients with type 2 diabetes and dyslipidaemia on background statin: Pre-specified analysis of the Chinese population from the BERSON clinical trial. Diabetes Obes Metab 2019; 21:1464-1473. [PMID: 30851062 PMCID: PMC6594089 DOI: 10.1111/dom.13700] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 12/26/2022]
Abstract
AIM The aim of this study was to evaluate the efficacy and safety of evolocumab with background atorvastatin in Chinese patients with type 2 diabetes mellitus (T2DM) and hyperlipidaemia or mixed dyslipidaemia. MATERIALS AND METHODS This is a pre-specified analysis of patients in the BERSON study (ClinicalTrials.gov, NCT02662569) in China. Patients initiated background atorvastatin 20 mg/d, after which they were randomized 2:2:1:1 to evolocumab 140 mg every 2 weeks (Q2W) or 420 mg monthly (QM) or to placebo Q2W or QM. Co-primary endpoints were percentage change in LDL cholesterol (LDL-C) from baseline to week 12 and from baseline to the mean of weeks 10 and 12. Additional endpoints included atherogenic lipids, glycaemic measures and adverse events (AEs). RESULTS Among 453 patients randomized in China, 451 received at least one dose of study drug (evolocumab or placebo). Evolocumab significantly reduced LDL-C compared with placebo at week 12 (Q2W, -85.0%; QM, -74.8%) and at the mean of weeks 10 and 12 (Q2W, -80.4%; QM, -81.0%) (adjusted P < 0.0001 for all) when administered with background atorvastatin. Non-HDL-C, ApoB100, total cholesterol, Lp(a), triglycerides, HDL-C and VLDL-C significantly improved with evolocumab vs placebo. No new safety findings were observed with evolocumab. The incidence of diabetes AEs was higher with evolocumab compared with placebo. There were no differences over time between evolocumab and placebo in measures of glycaemic control. CONCLUSIONS In patients in China with T2DM and hyperlipidaemia or mixed dyslipidaemia receiving background atorvastatin, evolocumab significantly reduced LDL-C and other atherogenic lipids, was well tolerated, and had no notable impact on glycaemic measures.
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Affiliation(s)
- Yundai Chen
- Department of CardiologyChinese People's Liberation Army General HospitalBeijingChina
| | - Zuyi Yuan
- First Affiliated Hospital of Xi'an Jiaotong UniversityShaanxiChina
| | - Juming Lu
- Department of EndocrinologyChinese People's Liberation Army General HospitalBeijingChina
| | | | - Alberto J. Lorenzatti
- Clinical Research and Cardiology, Instituto Medico DAMIC / Fundación RusculledaCórdobaArgentina
| | | | - Nan Wang
- Clinical Development, Amgen Inc.Thousand OaksCalifornia
| | | | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular DiseasesZhongshan Hospital, Fudan UniversityShanghaiChina
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13
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Drug Treatment of Hyperlipidemia in Chinese Patients: Focus on the Use of Simvastatin and Ezetimibe Alone and in Combination. Am J Cardiovasc Drugs 2019; 19:237-247. [PMID: 30714088 DOI: 10.1007/s40256-018-00317-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Elevated serum low-density lipoprotein cholesterol (LDL-C) is a major risk factor for coronary heart disease (CHD). Many guidelines recommend LDL-C as a primary treatment target, and statins represent the cornerstone of treatment for lipid management. Recently revised guidelines recommend even more intense management of LDL-C, especially in patients at moderate and high risk. However, LDL-C levels in the Chinese population differ from those in Western populations, and the benefits and safety of the maximum allowable dose of statins have yet to be determined. Furthermore, in practice, many patients do not achieve the increasingly stringent LDL-C goals. Consequently, alternative approaches to lipid management are required. Combination therapy with ezetimibe and a statin, which have complementary mechanisms of action, is more effective than statin monotherapies, even at high doses. Several clinical studies have consistently shown that combination therapy with ezetimibe and simvastatin lowers LDL-C more potently than statin monotherapies. Moreover, the safety and tolerability profile of the combination therapy appears to be similar to that of low-dose statin monotherapies. This review discusses the role of simvastatin in combination with ezetimibe in controlling dyslipidemia in Chinese patients, particularly the efficacy and safety of combination therapy in light of recently published clinical data.
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Narindrarangkura P, Bosl W, Rangsin R, Hatthachote P. Prevalence of dyslipidemia associated with complications in diabetic patients: a nationwide study in Thailand. Lipids Health Dis 2019; 18:90. [PMID: 30954084 PMCID: PMC6451778 DOI: 10.1186/s12944-019-1034-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 03/28/2019] [Indexed: 11/15/2022] Open
Abstract
Background Dyslipidemia is an important modifiable risk factor for cardiovascular disease. It is diagnosed by the presence of an abnormal lipid profile, primarily with elevated levels of plasma cholesterol, triglyceride, or both, or reduced levels of high-density lipoprotein cholesterol. However, some studies have reported increased risk of ischemic stroke with elevated low-density lipoprotein cholesterol (LDL-C) levels and increased risk of cardiovascular mortality independent of LDL-C levels in type 2 diabetes mellitus (T2DM) patients. Methods In this cross-sectional study, data were included for Thai adults with diabetes from the Diabetes Mellitus/ Hypertension (DM/HT) study, 2010–2014 (data was collected by the Medical Research Network of the Consortium of Thai Medical Schools). The target population comprised T2DM patients who were treated at a hospital for more than 12 months. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated to determine factors associated with dyslipidemia. Results In total, 140,557 participants (average age, 60 years) were enrolled, with a dyslipidemia prevalence of 88.9% in the cohort. The factors associated with dyslipidemia included female sex (aOR: 1.47, 95% CI: 1.38–1.56); age < 50 years (aOR: 1.16, 95% CI: 1.10–1.22); waist circumference ≥ 90 cm in males and ≥ 80 cm in females (aOR: 1.23, 95% CI: 1.16–1.31); treatment at a primary care unit (aOR: 1.28, 95% CI: 1.23–1.33); and a history of unknown stroke (aOR: 1.10, 95% CI: 1.02–1.19), coronary revascularization (aOR: 0.85, 95% CI: 0.79–0.91), diabetic nephropathy (aOR: 1.06, 95% CI: 1.01–1.12), or renal insufficiency (aOR: 1.08, 95% CI: 1.02–1.13). Conclusions Dyslipidemia is prevalent among Thai T2DMpatients and is associated with gender; age; obesity; central obesity; treatment at a primary care unit; and a history of unknown stroke, coronary revascularization, diabetic nephropathy, and renal insufficiency. Our study results will help increase the awareness of healthcare providers regarding dyslipidemia in diabetic patients. To reduce cardiovascular risk, healthcare professionals should provide regular follow-up and proper advice and ensure primary prevention of vascular complications. Improved education and increased self-awareness regarding the need to change behaviors and regular intake of medication would help decrease dyslipidemia prevalence among diabetic patients.
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Affiliation(s)
- Ploypun Narindrarangkura
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, 315 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - William Bosl
- Health Informatics Program, School of Nursing and Health Professions of the University of San Francisco, 2130 Fulton St, San Francisco, CA, 94117, USA
| | - Ram Rangsin
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, 315 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Panadda Hatthachote
- Department of Physiology, Phramongkutklao College of Medicine, 315 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand
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15
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Chao TH, Hsiao PJ, Liu ME, Wu CJ, Chiang FT, Chen ZC, Chen CP, Yeh HI, Lee TH, Chiang CE. A subanalysis of Taiwanese patients from ODYSSEY South Korea and Taiwan study evaluating the efficacy and safety of alirocumab. J Chin Med Assoc 2019; 82:265-271. [PMID: 30946207 DOI: 10.1097/jcma.0000000000000062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Alirocumab can provide significant reductions in low-density lipoprotein cholesterol (LDL-C). However, data regarding its efficacy and safety in Asians are limited. METHODS A subgroup analysis of Taiwanese patients (n = 116) in a randomized trial evaluating the efficacy and safety of alirocumab in South Korea and Taiwan (ODYSSEY KT, clinicaltrials.gov Identifier: NCT02289963) was performed. Patients with hypercholesterolemia at high cardiovascular risk on maximally tolerated statin were randomized to alirocumab (75 mg every 2 weeks; with dose increased to 150 mg at Week 12 if LDL-C ≥ 70 mg/dL at Week 8) or placebo for 24 weeks. The primary efficacy endpoint was the percent change in LDL-C from baseline to Week 24. Safety was assessed for a total of 32 weeks. RESULTS At Week 24, the percent change in calculated LDL-C in the alirocumab group (n = 57) was -51%, whereas that in the placebo group (n = 59) was 2.5%. Alirocumab significantly improved other lipid parameters, including non-high-density lipoprotein cholesterol, apolipoprotein B and A1, lipoprotein (a), high-density lipoprotein cholesterol, and total cholesterol. A significantly higher proportion of patients in the alirocumab group reached an LDL-C target below 70 mg/dL than those in the placebo group (81.3% vs 15.4%). The incidence of treatment-emergent adverse events was comparable between both groups. CONCLUSION Alirocumab treatment provided a favorable effect on LDL-C levels and other lipid parameters, and was generally well-tolerated in patients from Taiwan. The results of current analysis were consistent with the overall ODYSSEY phase 3 program.
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Affiliation(s)
- Ting-Hsing Chao
- Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Pi-Jung Hsiao
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Ming-En Liu
- Division of Cardiology, Department of Internal Medicine, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan, ROC
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung and Taoyuan, Taiwan, ROC
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, Fu-Jen Catholic University Hospital, New Taipei City, Taiwan, ROC
| | - Zhih-Cherng Chen
- Division of Cardiovascular Medicine, Chi-Mei Medical Center, Tainan, Taiwan, ROC
| | - Ching-Pei Chen
- Division of Cardiology, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Hung-I Yeh
- Division of Cardiology, Department of Medicine, Mackay Memorial Hospital, Mackay Medical College, Taipei and New Taipei City, Taiwan, ROC
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chern-En Chiang
- General Clinical Research Center, Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
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16
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Wang Y, Yan BPY, Tomlinson B, Nichol MB, Lee VWY. Clinical and Economic Analysis of Lipid Goal Attainments in Chinese Patients with Acute Coronary Syndrome Who Received Post-Percutaneous Coronary Intervention. J Atheroscler Thromb 2018; 25:1255-1273. [PMID: 29962381 PMCID: PMC6249357 DOI: 10.5551/jat.44818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/07/2018] [Indexed: 01/04/2023] Open
Abstract
AIM The recommended low-density lipoprotein cholesterol (LDL-C) levels of the guideline may be appropriate for Caucasian patients but not for other ethnic groups. METHODS A cohort study was conducted in Hong Kong, and acute coronary syndrome (ACS) patients who received percutaneous coronary intervention (PCI) between 2005 and 2015 were enrolled. The primary outcomes of interest were the total cost of care and cardiovascular-related cost during one-year follow-up. The cost difference by lipid goal attainments was analyzed by Poisson regression with multivariate treatment effects. The clinical outcomes achieved by lipid goal attainments in terms of major adverse cardiovascular events were analyzed by multivariate Cox regression. RESULTS Among the 4638 patients, 79.50%, 48.64%, and 36.14% attained the LDL-C goals of <2.6, <2.0, and <1.8 mmol/L for one year, respectively. Only about 16% patients achieved the ≥50% reduction from baseline. None of these lipid goals was associated with a significant reduction in the total cost of care. We only identified the clinical benefits associated with the lipid goal of <2.6 mmol/L. Other more stringent lipid goals seemed to bring a significant economic burden on cardiovascular-related cost, but their clinical benefits were uncertain. CONCLUSIONS Lowering LDL-C to achieve the guideline-recommended target levels for post-PCI ACS patients may lead to fewer cardiovascular events, but it may not necessarily lead to economic benefits within one year of follow-up.
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Affiliation(s)
- Yun Wang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Bryan Ping Yen Yan
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Brian Tomlinson
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael Bruce Nichol
- Sol Price School of Public Policy, Leonard D. Schaeffer Center for Health Policy and Economics, Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Vivian Wing Yan Lee
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Nagar SP, Rane PP, Fox KM, Meyers J, Davis K, Beaubrun A, Inomata H, Qian Y, Kajinami K. Treatment Patterns, Statin Intolerance, and Subsequent Cardiovascular Events Among Japanese Patients With High Cardiovascular Risk Initiating Statin Therapy. Circ J 2018; 82:1008-1016. [DOI: 10.1253/circj.cj-17-0811] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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18
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Pang J, Hu M, Lin J, Miida T, Nawawi HM, Park JE, Wu X, Ramli AS, Kim NT, Kwok S, Gonzalez-Santos LE, Su TC, Truong TH, Soran H, Yamashita S, Tomlinson B, Watts GF. An enquiry based on a standardised questionnaire into knowledge, awareness and preferences concerning the care of familial hypercholesterolaemia among primary care physicians in the Asia-Pacific region: the "Ten Countries Study". BMJ Open 2017; 7:e017817. [PMID: 29074516 PMCID: PMC5665281 DOI: 10.1136/bmjopen-2017-017817] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine physicians' knowledge, awareness and preferences regarding the care of familial hypercholesterolaemia (FH) in the Asia-Pacific region. SETTING A formal questionnaire was anonymously completed by physicians from different countries/regions in the Asia-Pacific. The survey sought responses relating to general familiarity, awareness of management guidelines, identification (clinical characteristics and lipid profile), prevalence and inheritance, extent of elevation in risk of cardiovascular disease (CVD) and practice on screening and treatment. PARTICIPANTS Practising community physicians from Australia, Japan, Malaysia, South Korea, Philippines, Hong Kong, China, Vietnam and Taiwan were recruited to complete the questionnaire, with the UK as the international benchmark. PRIMARY OUTCOME An assessment and comparison of the knowledge, awareness and preferences of FH among physicians in 10 different countries/regions. RESULTS 1078 physicians completed the questionnaire from the Asia-Pacific region; only 34% considered themselves to be familiar with FH. 72% correctly described FH and 65% identified the typical lipid profile, with a higher proportion of physicians from Japan and China selecting the correct FH definition and lipid profile compared with those from Vietnam and Philippines. However, less than half of the physician were aware of national or international management guidelines; this was significantly worse than physicians from the UK (35% vs 61%, p<0.001). Knowledge of prevalence (24%), inheritability (41%) and CVD risk (9%) of FH were also suboptimal. The majority of the physicians considered laboratory interpretative commenting as being useful (81%) and statin therapy as an appropriate cholesterol-lowering therapy (89%) for FH management. CONCLUSIONS The study identified important gaps, which are readily addressable, in the awareness and knowledge of FH among physicians in the region. Implementation of country-specific guidelines and extensive work in FH education and awareness programmes are imperative to improve the care of FH in the region.
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Affiliation(s)
- Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Miao Hu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jie Lin
- Department of Atherosclerosis, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hapizah M Nawawi
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Disciplines of Chemical Pathology and Primary Care, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Jeong Euy Park
- Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Xue Wu
- Department of Atherosclerosis, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Anis S Ramli
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Disciplines of Chemical Pathology and Primary Care, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Ngoc Thanh Kim
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - See Kwok
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Cardiovascular Trials Unit, The Old St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Lourdes E Gonzalez-Santos
- Department of Cardiology, Section of Preventive Cardiology and Hypertension, UP-Philippine General Hospital, Manila, Philippines
| | - Ta-Chen Su
- Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Thanh Huong Truong
- Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Handrean Soran
- Cardiovascular Trials Unit, The Old St Mary's Hospital, Central Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Shizuya Yamashita
- Department of Cardiovascular Medicine and Community Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- Rinku General Medical Center, Osaka, Japan
| | - Brian Tomlinson
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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Dwiputra B, Santoso A, Poh KK. Targeting pro-protein convertase subtilisin kexin-9 as a novel therapy of hypercholesterolemia. MEDICAL JOURNAL OF INDONESIA 2017. [DOI: 10.13181/mji.v26i2.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Reducing low density lipoprotein (LDL) cholesterol level is an established primary and secondary prevention strategy for coronary heart disease. However, not all patients are able to achieve their LDL targets as recommended by the guidelines. Over the last 10 years, high plasma LDL level is known to be associated with a higher level of pro-protein convertase subtilisin kexin-9 (PCSK-9). Loss-of-function mutations in the PCSK-9 gene is associated with lower plasma LDL level and cardiovascular risk. Since its discovery in 2003, PCSK-9 has triggered many researchers to design a PCSK-9 inhibitor to reduce LDL cholesterol through competitive inhibition of this molecule. Some phase III clinical trials have showed promising results of PCSK-9 inhibitor efficacy in lowering LDL level and improving clinical outcome. This article aims to discuss the role of PCSK-9 in LDL metabolism and the efficacy of PCSK-9 inhibitor in reducing plasma LDL level.
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Wang KF, Wu CH, Chang CC, Chen LC, Wang KL, Lu TM, Lin SJ, Chiang CE. Determinants of Treatment Modification in Hypercholesterolemic Patients. ACTA CARDIOLOGICA SINICA 2017; 33:156-164. [PMID: 28344419 DOI: 10.6515/acs20161215a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a lack of knowledge of those contemporary factors associated with modifying subtherapeutic treatments in hypercholesterolemic patients. The aim of this study was to assess determinants of treatment modification in patients not attaining their low-density lipoprotein cholesterol goals. METHODS The CEntralized Pan-Asian survey on tHE Under-treatment of hypercholeSterolemia enrolled patients taking stable lipid-lowering medications. The study physicians then determined existing patient treatments, which were to be continued or modified when treatments failed. The patient questionnaire surveying patient attitudes and perceptions toward their hypercholesterolemia management was prospectively collected. The odds ratios (ORs) (95% confidence intervals) were calculated. RESULTS Among the 420 patients included for analysis, 35.7% were designated for planned treatment modification. Those patients assigned to treatment modification were more likely to have a family history of premature coronary heart disease (40% vs. 19%), an indication for secondary prevention (76% vs. 61%), elevated triglyceride (60% vs. 48%) and fasting sugar (84% vs. 67%), and were less adherent to their medications (29% vs. 12%) than patients assigned to treatment continuation. Patient recognition of treatment failure [OR, 1.82 (1.13-2.94)], the lower frequency of cholesterol checkup [OR, 2.40 (1.41-4.08)], patient satisfaction with provided cholesterol information [OR, 2.30 (1.21-4.39)], and their feelings toward cholesterol management [OR, 0.25 (0.10-0.62) and 3.80 (2.28-6.32)] for confusion and no strong feeling, respectively were determinants of the treatment modification assignment. CONCLUSIONS There was a large gap between evidence-based goals and modification of subtherapeutic treatments, particularly among patients with lower treatment satisfaction and better compliance. Our findings have emphasized the need to further reduce inertia in implementing hypercholesterolemia management.
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Affiliation(s)
- Ko-Fan Wang
- School of Medicine, National Yang-Ming University
| | | | | | - Lung-Ching Chen
- School of Medicine, National Yang-Ming University; ; Department of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital
| | - Kang-Ling Wang
- School of Medicine, National Yang-Ming University; ; General Clinical Research Center; ; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tse-Min Lu
- School of Medicine, National Yang-Ming University
| | - Shing-Jong Lin
- School of Medicine, National Yang-Ming University; ; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chern-En Chiang
- School of Medicine, National Yang-Ming University; ; General Clinical Research Center; ; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
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Wu NQ, Guo YL, Ye P, Chen H, Li YF, Hua Q, Zhu CG, Gao Y, Qing P, Li XL, Wang Y, Liu G, Dong Q, Li JJ. Statins usage and target achievement of LDL-C level in Chinese patients with coronary artery disease impacted by 2013 ACC/AHA cholesterol guideline. IJC METABOLIC & ENDOCRINE 2017; 14:33-37. [DOI: 10.1016/j.ijcme.2016.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
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Abstract
INTRODUCTION Data on statin safety in Asian patients are limited compared with evidence from Western populations. AIM This study assessed atorvastatin safety among Asian patients enrolled in 58 randomized clinical trials. METHODS Data from 52 short-term trials (median exposure 4-72 weeks) and six long-term cardiovascular outcomes trials (median exposure 3.1-4.9 years) conducted across the atorvastatin 10-80-mg dose range were analyzed retrospectively to assess the incidence of safety endpoints. RESULTS A total of 77 952 patients were identified (49 974 received atorvastatin), among whom 3191 were Asian (2519 received atorvastatin). In the short-term trials, the incidence of all-causality adverse events (AEs) and serious AEs (SAEs) in Asian patients treated with atorvastatin was similar to or lower than that observed with other statins or placebo, and discontinuations due to treatment-related AEs/SAEs were infrequent (2.0% across all doses). These observations were confirmed in the long-term trials. Treatment-related SAEs were rare (n = 4) among Asian patients receiving atorvastatin. No cases of rhabdomyolysis were observed in atorvastatin-treated Asian patients, and the incidence of myalgia was 1.8% in the short-term studies and 6.7% in the long-term trials. Elevations (>3× the upper limit of normal) in liver transaminases were observed in ~2% of Asian patients receiving atorvastatin; renal AEs occurred in <2%. CONCLUSION The incidence of AEs/SAEs with atorvastatin 10-40-mg in patients of Asian origin was low and comparable to placebo. Further evaluation of atorvastatin 80-mg is required owing to the limited number of Asian patients (n = 281; 11.2%) who received this dose.
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Affiliation(s)
- Juliana C. N. Chan
- Department of Medicine and TherapeuticsHong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongPrince of Wales HospitalShatin NT, Hong Kong SARChina
| | - Alice P. S. Kong
- Department of Medicine and TherapeuticsHong Kong Institute of Diabetes and ObesityThe Chinese University of Hong KongPrince of Wales HospitalShatin NT, Hong Kong SARChina
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Mendelson MM, Regh T, Chan J, Baker A, Ryan HH, Palumbo N, Johnson PK, Griggs S, Boghani M, Desai NK, Yellen E, Buckley L, Gillman MW, Zachariah JP, Graham D, de Ferranti SD. Correlates of Achieving Statin Therapy Goals in Children and Adolescents with Dyslipidemia. J Pediatr 2016; 178:149-155.e9. [PMID: 27592099 PMCID: PMC5085848 DOI: 10.1016/j.jpeds.2016.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/30/2016] [Accepted: 08/02/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine the real-world effectiveness of statins and impact of baseline factors on low-density lipoprotein cholesterol (LDL-C) reduction among children and adolescents. STUDY DESIGN We analyzed data prospectively collected from a quality improvement initiative in the Boston Children's Hospital Preventive Cardiology Program. We included patients ≤21 years of age initiated on statins between September 2010 and March 2014. The primary outcome was first achieving goal LDL-C, defined as <130 mg/dL, or <100 mg/dL with high-level risk factors (eg, diabetes, etc). Cox proportional hazards models were used to assess the impact of baseline clinical and lifestyle factors. RESULTS Among the 1521 pediatric patients evaluated in 3813 clinical encounters over 3.5 years, 97 patients (6.3%) were started on statin therapy and had follow-up data (median age 14 [IQR 7] years, 54% were female, and 24% obese, 62% with at least one lifestyle risk factor). The median baseline LDL-C was 215 (IQR 78) mg/dL, and median follow-up after starting statin was 1 (IQR 1.3) year. The cumulative probability of achieving LDL-C goal within 1 year was 60% (95% CI 47-69). A lower probability of achieving LDL-C goals was associated with male sex (HR 0.5 [95% CI 0.3-0.8]) and higher baseline LDL-C (HR 0.92 [95% CI 0.87-0.98] per 10 mg/dL), but not age, body mass index percentile, lifestyle factors, or family history. CONCLUSIONS The majority of pediatric patients started on statins reached LDL-C treatment goals within 1 year. Male patients and those with greater baseline LDL-C were less likely to be successful and may require increased support.
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Affiliation(s)
- Michael M Mendelson
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Boston University School of Medicine, Boston University, Boston, MA.
| | - Todd Regh
- Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, MA
| | - James Chan
- Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, MA
| | - Annette Baker
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | | | - Nicole Palumbo
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Philip K Johnson
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Suzanne Griggs
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Meera Boghani
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - Nirav K Desai
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA
| | - Elizabeth Yellen
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Boston University School of Medicine, Boston University, Boston, MA
| | - Lucy Buckley
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Matthew W Gillman
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA
| | | | - Dionne Graham
- Institute for Relevant Clinical Data Analytics (IRCDA), Boston Children's Hospital, Boston, MA
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Tan NC, Goh CC, Goh SCP, Koh YLE, Koh KH. The effect of the intensity of lipid-lowering medications on the LDL cholesterol treatment goals of Asian patients with dyslipidaemia in primary care. J Clin Pharm Ther 2016; 41:677-683. [PMID: 27641514 DOI: 10.1111/jcpt.12447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/19/2016] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Dyslipidaemia is the key risk factor for arthrosclerosis, leading to myocardial infarctions and strokes. Achieving LDL cholesterol (LDL-C) treatment goals using lipid-lowering therapy (LLT) mitigates such cardiovascular risks. This study aimed to determine the proportions and factors influencing patients with dyslipidaemia on LLT who achieved their recommended LDL-C treatment goals. METHODS Adult Asian patients with dyslipidaemia, aged 31-80 years, were enrolled in a questionnaire survey. Using simplified Framingham risk scores, these patients were classified into low (LR), medium (MR) and high (HR) cardiovascular risk groups. Their lipid-lowering therapy was classified into low-intensity (LI), medium-intensity (MI) and high-intensity (HI) groups according to the 2013 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guidelines. Data on their demographic, clinical, self-reported attitude and adherence to LLT were correlated with their latest lipid profiles from their electronic health records. These data were analysed using chi-square test, or independent t-test where appropriate for categorical variables and continuous data. Logistic regression was used to identify factors relating to LDL-C goal attainment. RESULTS AND DISCUSSION Amongst the 917 patients treated with LLT, 60·9% were females and 56·2% aged >60 years. The commonest statins prescribed were simvastatin (77·7%), atorvastatin (15·3%), rosuvastatin (4·3%) and lovastatin (3·4%). Those who attained LDL-C treatment goals included 89·4%, 77·4% and 70% of the LR, MR and HR groups. Overall, 72·4% of the patients achieved LDL-C treatment goals. Despite 98·4% of them self-reported LLT adherence, only 85·5%, 69·5% and 50% of the LI, MI and HI subgroups attained the desired outcomes, respectively. WHAT IS NEW AND CONCLUSION Overall, 27·6% of patients with dyslipidaemia, including 30% of the HR group, did not achieve LDL-C treatment goals, despite on LLT. Addressing their concerns and adjusting medication doses of their LLT are needed for better outcomes.
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Affiliation(s)
- N C Tan
- SingHealth Polyclinics, Singapore, Singapore. .,Duke NUS Medical School, Singapore, Singapore.
| | - C C Goh
- SingHealth Polyclinics, Singapore, Singapore
| | - S C P Goh
- SingHealth Polyclinics, Singapore, Singapore.,Duke NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Y L E Koh
- SingHealth Polyclinics, Singapore, Singapore
| | - K H Koh
- SingHealth Polyclinics, Singapore, Singapore
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25
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Yan P, Tan EKK, Choo JCJ, Liew CFS, Lau T, Waters DD. Statin-centric versus low-density lipoprotein-centric approach for atherosclerotic cardiovascular disease prevention: a Singapore perspective. Singapore Med J 2016; 57:360-7. [PMID: 27439304 PMCID: PMC4958711 DOI: 10.11622/smedj.2016118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The link between cholesterol levels and atherosclerotic cardiovascular disease (ASCVD) is well-established. In Singapore, there is an increasing prevalence of risk factors for ASCVD. Like many Asian countries, Singapore's population is rapidly ageing and increasingly sedentary, which predisposes individuals to chronic health problems. Current international and local guidelines recommend statin therapy for the primary and secondary prevention of ASCVD. However, despite the effectiveness of statin therapy, some studies have highlighted that Asian patients with cardiovascular disease are not achieving target lipid goals. Furthermore, it is widely believed that the responses of Asians (both patients and physicians) to statin therapy are different from those of their Western counterparts. Experts convened in 2014 to determine the impact of current guidelines on clinical practice in Singapore. This review summarises the key findings and recommendations of these guidelines, and presents key principles to aid clinicians to manage the cardiovascular risk of their patients more effectively.
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Affiliation(s)
- Peter Yan
- Peter Yan Cardiology Clinic, Gleneagles Hospital, Singapore
| | - Eng Kiat Kevin Tan
- Kevin Tan Clinic for Diabetes, Thyroid and Hormones Pte Ltd, Mount Elizabeth Medical Centre, Singapore
| | | | | | - Titus Lau
- Division of Nephrology, National University Health System, National University Hospital, Singapore
| | - David D Waters
- Department of Medicine, University of California, San Francisco, USA
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Kim HS, Kim H, Lee H, Park B, Park S, Lee SH, Cho JH, Song H, Kim JH, Yoon KH, Choi IY. Analysis and comparison of statin prescription patterns and outcomes according to clinical department. J Clin Pharm Ther 2016; 41:70-7. [PMID: 26791968 DOI: 10.1111/jcpt.12350] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE There is a disparity between the Korean treatment guidelines and actual clinical prescription habits. This study was designed to evaluate the department-specific disparities and achievement rates for low-density lipoprotein cholesterol (LDL-C) targets, based on each department's specific statin prescription patterns. METHODS We retrospectively evaluated data from 31 718 patients who had been prescribed a statin at least once between January 2008 and June 2013 at our institution. Patients were classified into the high-risk (target LDL-C < 100 mg/dL) or moderate-risk (target LDL-C < 130 mg/dL) groups, according to the National Cholesterol Education Programme-Adult Treatment Panel III guidelines. RESULTS AND DISCUSSION Statins were most commonly prescribed in the cardiology (32·0%) and endocrinology (26·6%) departments. For the high-risk group, 70% of patients in the cardiology, endocrinology and cardiac surgery departments achieved their target LDL-C levels (<100 mg/dL). However, the target achievement rates in most other departments were <70%. For the moderate-risk group, 79·2% of patients achieved their target levels. Departments that prescribed a greater number of high- or intermediate-potency statins were more likely to achieve their target LDL-C levels. The group that achieved their target LDL-C levels (<100 mg/dL) exhibited a significant positive relationship (Spearman's correlation coefficient = 0·8571, P = 0·0065), from low to high potency. WHAT IS NEW AND CONCLUSION Some departments tend to undertreat when prescribing statins. However, to reach to the target LDL-C levels, physicians must overcome their tendency to undertreat with statins. We believe that the target achievement rate will increase if doctors are more actively aware of a patient's individual status and related risk factors before prescribing statins.
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Affiliation(s)
- H-S Kim
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, Korea
| | - H Lee
- Department of Industrial and Management Engineering, Pohang University of Science and Technology, Pohang, Korea
| | - B Park
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Information System, Hanyang University, Seoul, Korea
| | - S Park
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Information System, Hanyang University, Seoul, Korea
| | - S-H Lee
- Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J H Cho
- Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - H Song
- Department of Thoracic and Cardiovascular surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - J H Kim
- Division of Biomedical Informatics, Systems Biomedical Informatics Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - K-H Yoon
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - I Y Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Chiang CE, Ferrières J, Gotcheva NN, Raal FJ, Shehab A, Sung J, Henriksson KM, Hermans MP. Suboptimal Control of Lipid Levels: Results from 29 Countries Participating in the Centralized Pan-Regional Surveys on the Undertreatment of Hypercholesterolaemia (CEPHEUS). J Atheroscler Thromb 2015; 23:567-87. [PMID: 26632163 DOI: 10.5551/jat.31179] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Five multicentre, cross-sectional Centralized Pan-Regional Surveys on the Undertreatment of Hypercholesterolaemia (CEPHEUS) were conducted in 29 countries across Asia, Western Europe, Eastern Europe, the Middle East, and Africa. The surveys assessed the current use and efficacy of lipid-lowering drugs (LLDs) worldwide and identified possible patient and physician characteristics associated with failure to attain low-density lipoprotein cholesterol (LDL-C) goals. The aim of this analysis was to consolidate the global results from these surveys. METHODS The surveys involved patients aged ≥18 years who had been prescribed LLDs for at least 3 months without dose changes for at least 6 weeks. A single visit was scheduled for data collection, including fasting plasma lipid and glucose levels. Cardiovascular risk profile and LDL-C goal attainment were assessed according to the 2004 updated US National Cholesterol Education Program Adult Treatment Panel III guidelines. RESULTS In total, 35 121 patients (mean age: 60.4 years) were included, and 90.3% had been prescribed statin monotherapy. Overall, only 49.4% of patients reached their recommended LDL-C level. LDL-C goals were attained in 54.8% (5084/9273) and 22.8% (3287/14 429) of patients were at high and very high cardiovascular risk, respectively. Factors associated with an increased likelihood of LDL-C goal attainment were lower baseline cardiovascular risk; presence of diabetes mellitus, hypertension, or history of cardiovascular disease; and treatment with simvastatin, atorvastatin, or rosuvastatin (vs. all other LLDs). CONCLUSION LDL-C goal attainment in patients taking LLDs is suboptimal worldwide, particularly in patients at high and very high cardiovascular risk.
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Affiliation(s)
- Chern-En Chiang
- General Clinical Research Center, Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University
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Effects of Adherence to Statin Therapy on Health Care Outcomes and Utilizations in Taiwan: A Population-Based Study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:149573. [PMID: 26539464 PMCID: PMC4619755 DOI: 10.1155/2015/149573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 11/18/2022]
Abstract
Aim. Good medication adherence may decrease the probability of worse outcomes and reduce unnecessary medical care costs. This study aims to evaluate medication adherence for people on statin therapy. Methods. National health insurance databases were analyzed from January 1, 2001, to December 31, 2007. Study samples were patients of 45 years and older adults who took statin for the first time during the study period. Medication possession ratio (MPR) was measured until the patients had hospitalization or reached the three-year follow-up period. We identified a good (MPR ≥ 80%) and a poor (MPR < 80%) medication adherence group to conduct statistical analyses. Results. 40.8% of patients were of good medication adherence and 59.2% were of poor medication adherence. Multivariate logistic regression model indicated that the MPR ≥ 80% group had significantly less probability of hospitalization (P < 0.001). Being men, increasing age, higher Charlson Comorbidity Index (CCI) scores, seeking care mostly in the medical center or teaching hospitals, and living in the suburban or rural areas had higher probability of hospitalization (P < 0.05 or P < 0.001). The MPR ≥ 80% group spent less hospitalization expenditures (P < 0.001). Conclusion. Effective interventions may be applied to the poor medication adherence group in order to improve their health care outcomes.
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Setia S, Fung SSW, Waters DD. Doctors' knowledge, attitudes, and compliance with 2013 ACC/AHA guidelines for prevention of atherosclerotic cardiovascular disease in Singapore. Vasc Health Risk Manag 2015; 11:303-10. [PMID: 26082642 PMCID: PMC4461017 DOI: 10.2147/vhrm.s82710] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE There is an unmet need for strategies to prevent atherosclerotic cardiovascular disease in Singapore. The main objective of this study was to investigate Singapore physicians' response to the 2013 American College of Cardiology and American Heart Association (ACC/AHA) guidelines for treatment of cholesterol and their impact on clinical practice. METHODS This survey was conducted in two stages, qualitative and quantitative. Physicians were initially screened on the basis of an initial screener questionnaire, and eligible physicians were then included in the study. RESULTS Qualitative (n=19) and quantitative (n=66) surveys were completed by eligible physicians from Singapore. Physicians were less familiar with the 2013 ACC/AHA guidelines (35%) as compared with the Singapore Ministry of Health (MoH) lipid guidelines 2006 (49%). Of the physicians whose opinion was sought on the ACC/AHA guidelines, more than 50% disagreed with the definition of high-, moderate-, and low-intensity statin therapy; recommendation of atorvastatin 40-80 mg and rosuvastatin 20-40 mg as medications for high-intensity statin therapy; and classification of individuals who would benefit from moderate- to high-intensity statin therapy. Most physicians assumed that Asians may be intolerant to high-intensity statin therapy. CONCLUSION Although embracing the 2013 ACC/AHA guidelines in clinical practice is expected to provide better clinical care to patients, our study revealed high reluctance by physicians, especially in the use of high-dose statins. However, ACC/AHA guidelines can be easily adopted in Asia as there is a wealth of data available for atorvastatin in primary and secondary prevention of atherosclerotic cardiovascular disease with similar efficacy and safety profiles in the white and Asian populations.
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Affiliation(s)
| | | | - David D Waters
- Department of Medicine, University of California, San Francisco, CA, USA
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Chinwong D, Patumanond J, Chinwong S, Siriwattana K, Gunaparn S, Hall JJ, Phrommintikul A. Low-density lipoprotein cholesterol of less than 70 mg/dL is associated with fewer cardiovascular events in acute coronary syndrome patients: a real-life cohort in Thailand. Ther Clin Risk Manag 2015; 11:659-67. [PMID: 25987839 PMCID: PMC4420548 DOI: 10.2147/tcrm.s78745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Elevated low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk of cardiovascular disease or mortality; however, the LDL-C goal for therapy in acute coronary syndrome (ACS) patients is controversial and varies among guidelines. This study aimed to assess the effect of reaching an LDL-C goal of <70 mg/dL (<1.8 mmol/L) on first composite cardiovascular outcomes in routine clinical practice in Thailand. METHODS A retrospective cohort study was conducted using medical charts and the electronic hospital database of patients diagnosed with ACS and treated with statins at a tertiary care hospital in Thailand between 2009 and 2012. After admission, patients were followed from the date of LDL-C goal assessment until the first event of composite cardiovascular outcomes (nonfatal ACS, nonfatal stroke, or all-cause death). Cox proportional hazard models adjusted for potential confounders were used. RESULTS Of 405 patients, mean age was 65 years (60% males). Twenty-seven percent of the patients attained an LDL-C goal of <70 mg/dL, 38% had LDL-C between 70 and 99 mg/dL, and 35% had LDL-C ≥100 mg/dL. Forty-six patients experienced a composite cardiovascular outcome. Compared with patients with an LDL-C ≥100 mg/dL, patients achieving an LDL-C of <70 mg/dL were associated with a reduced composite cardiovascular outcome (adjusted hazard ratio [HR]=0.42; 95% confidence interval [CI]=0.18-0.95; P-value=0.037), but patients with an LDL-C between 70 and 99 mg/dL had a lower composite cardiovascular outcome, which was not statistically significant (adjusted HR=0.73; 95% CI=0.37-1.42; P-value=0.354). CONCLUSION ACS patients who received statins and achieved an LDL-C of <70 mg/dL had significantly fewer composite cardiovascular outcomes, confirming "the lower the better" and the benefit of treating to LDL-C target in ACS patient management.
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Affiliation(s)
- Dujrudee Chinwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jayanton Patumanond
- Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Surarong Chinwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | | | - Siriluck Gunaparn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - John Joseph Hall
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Arintaya Phrommintikul
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Ho LT, Yin WH, Chuang SY, Tseng WK, Wu YW, Hsieh IC, Lin TH, Li YH, Huang LC, Wang KY, Ueng KC, Fang CC, Pan WH, Yeh HI, Wu CC, Chen JW. Determinants for achieving the LDL-C target of lipid control for secondary prevention of cardiovascular events in Taiwan. PLoS One 2015; 10:e0116513. [PMID: 25756522 PMCID: PMC4355583 DOI: 10.1371/journal.pone.0116513] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 11/28/2014] [Indexed: 11/05/2022] Open
Abstract
Background Epidemiological and clinical studies have clearly established the link between low-density lipoprotein cholesterol (LDL-C) and atherosclerosis-related cardiovascular consequences. Although it has been a common practice for physicians to prescribe lipid-lowering therapy for patients with dyslipidemia, the achievement rate is still not satisfied in Taiwan. Therefore, the determinants for achieving the LDL-C target needed to be clarified for better healthcare of the patients with dyslipidemia. Method This registry-type prospective observational study enrolled the patients with cardiovascular diseases (coronary artery disease (CAD) and cerebrovascular disease (CVD)) from 18 medical centers across Taiwan, and clinically followed them for five years. At every clinical visit, vital signs, clinical endpoints, adverse events, concurrent medications and laboratory specimens were obtained as thoroughly as possible. The lipid profile (total cholesterol, high-density lipoprotein cholesterol, LDL-C, triglyceride), liver enzymes, and creatinine phosphokinase were evaluated at baseline, and every year thereafter. The cross sectional observational data was analyzed for this report. Result Among the 3,486 registered patients, 54% had their LDL-C < 100 mg/dL. By univariate analysis, the patients achieving the LDL-C target were associated with older age, more male sex, taller height, lower blood pressure, more under lipid-lowering therapy, more smoking cessation, more history of CAD, DM, physical activity, but less history of CVD. The multivariate analysis showed statin therapy was the most significant independent determinant for achieving the treatment target, followed by age, history of CAD, diabetes, blood pressure, and sex. However, most patients were on regimens of very-low to low equipotent doses of statins. Conclusion Although the lipid treatment guideline adherence is improving in recent years, only 54% of the patients with cardiovascular diseases have achieved their LDL-C target in Taiwan, and the most significant determinant for this was statin therapy.
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Affiliation(s)
- Li-Ting Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Wei-Kung Tseng
- Department of Medical Imaging and Radiological Sciences, I-Shou University and Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - I-Chang Hsieh
- Second Department of Cardiology, Chang-Gung Memorial Hospital, New Taipei City, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Heng Li
- Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Lien-Chi Huang
- Department of Cardiology, Taipei Union Hospital, Taipei, Taiwan
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital and Department of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Kwo-Chang Ueng
- School of Medicine, Chung Shan Medical University and Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Chang Fang
- Division of Cardiology, Department of Internal Medicine, Tainan Municipal Hospital, Tainan, Taiwan
| | - Wen-Harn Pan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
| | - Chau-Chung Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
- Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| | - Jaw-Wen Chen
- Department of Medical Research and Education, Taipei Veterans General Hospital and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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Chinwong D, Patumanond J, Chinwong S, Siriwattana K, Gunaparn S, Hall JJ, Phrommintikul A. Statin therapy in patients with acute coronary syndrome: low-density lipoprotein cholesterol goal attainment and effect of statin potency. Ther Clin Risk Manag 2015; 11:127-36. [PMID: 25670902 PMCID: PMC4315463 DOI: 10.2147/tcrm.s75608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Elevated low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk of coronary artery disease. Current guidelines recommend an LDL-C target of <70 mg/dL (<1.8 mmol/L) for acute coronary syndrome (ACS) patients, and the first-line treatment to lower lipids is statin therapy. Despite current guidelines and the efficacious lipid-lowering agents available, about half of patients at very high risk, including ACS patients, fail to achieve their LDL-C goal. This study assessed LDL-C goal attainment according to use of high and low potency statins in routine practice in Thailand. Methods A retrospective cohort study was performed by retrieving data from medical records and the electronic hospital database for a tertiary care hospital in Thailand between 2009 and 2011. Included were ACS patients treated with statins at baseline and with follow-up of LDL-C levels. Patients were divided into high or low potency statin users, and the proportion reaching the LDL-C goal of <70 mg/dL was determined. A Cox proportional hazard model was applied to determine the relationship between statin potency and LDL-C goal attainment. Propensity score adjustment was used to control for confounding by indication. Results Of 396 ACS patients (60% males, mean age 64.3±11.6 years), 229 (58%) were treated with high potency statins and 167 (42%) with low potency statins. A quarter reached their target LDL-C goal (25% for patients on high potency statins and 23% on low potency statins). High potency statins were not associated with increased LDL-C goal attainment (adjusted hazards ratio 1.22, 95% confidence interval 0.79–1.88; P=0.363). Conclusion There was no significant effect of high potency statins on LDL-C goal attainment. Moreover, this study showed low LDL-C goal attainment for patients on either low or high potency statins. The reasons for the low LDL-C goal attainment rate warrants further investigation.
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Affiliation(s)
- Dujrudee Chinwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand ; Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jayanton Patumanond
- Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Surarong Chinwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | | | - Siriluck Gunaparn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - John Joseph Hall
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia
| | - Arintaya Phrommintikul
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Chen CY, Chuang SY, Fang CC, Huang LC, Hsieh IC, Pan WH, Yeh HI, Wu CC, Yin WH, Chen JW. Gender disparities in optimal lipid control among patients with coronary artery disease. J Atheroscler Thromb 2014; 21 Suppl 1:S20-8. [PMID: 24452112 DOI: 10.5551/jat.21_sup.1-s20] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Coronary heart disease(CHD) is the leading cause of death worldwide in both men and women. Hypercholesterolemia is a major factor contributing to the incidence of CHD. Many lipid-lowering trials have shown statins to be effective medications for the primary and secondary prevention of CHD. Some studies have suggested that statins are as or more effective in women than in men. However, there is a substantial gender gap in lipid goal attainment with respect to primary care guidelines, as reported in observational studies. In this article, we attempt to explain gender differences in lipid control in individuals with or at risk of CHD in order to improve awareness of and narrow gaps in gender disparities in lipid management.
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Affiliation(s)
- Chun-Yen Chen
- Cardiovascular Division, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medical College
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Unniachan S, Bash LD, Khovidhunkit W, Sri RZT, Vicaldo E, Recto C, Ambegaonkar BM. Prevalence of lipid abnormalities and attainment of normal lipid levels among patients with dyslipidaemia: a pooled analysis of observational studies from five Asian countries. Int J Clin Pract 2014; 68:1010-9. [PMID: 24666791 DOI: 10.1111/ijcp.12407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS Guidelines emphasise the importance of low-density lipoprotein cholesterol (LDL-C) goals for cardiovascular risk reduction. Given the importance of association between high-density lipoprotein (HDL-C) and triglycerides (TG) normal levels and cardiovascular risk, there is an additional need to further evaluate diverse dyslipidaemic populations. METHODS A retrospective longitudinal observational study of patients aged ≥ 35 years on lipid-modifying therapy (LMT) for ≥ 12 months was conducted from patient records pooled from five Asian countries (Malaysia, Korea, Hong Kong, Thailand and Philippines). The prevalence of lipid abnormalities and goal attainment was assessed 12 months before and after LMT initiation. RESULTS Among 3256 patients (mean age - 58.6 years, 50.4% men), 65.4% were high-risk patients and 88% were on statin therapy. At baseline 94.7% of all patients had at least one abnormal lipid value elevated, LDL-C (86.2%) being the most prevalent. Non-smokers [OR (95% CI): 1.42 (1.08-1.87)], non-diabetics [2.35 (1.96-2.82)], non-cardiovascular disease patients [1.77 (1.42-2.21)] and those from Korea [2.56 (1.83-3.59)] were more likely to attain LDL-C goals. On the contrary, women [0.82 (0.68-0.98)], subjects with FRS > 20% [0.56 (0.41-0.77)] those from Malaysia [0.55 (0.39-0.77)] and the Philippines [0.18 (0.12-0.28)] were less likely to reach LDL-C goals. Fewer characteristics were independently associated with reaching normal levels of HDL-C and TG and attaining at least two normal lipid levels. CONCLUSIONS While current LMT reduced the prevalence of dyslipidaemia, a third of patients still failed to achieve target/normal levels. We highlight country differences and the importance of improving therapy to attain multiple lipid goals/normal levels.
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Affiliation(s)
- S Unniachan
- School of Public Health, UMDNJ, Piscataway, NJ, USA
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Chang CH, Lin JW, Lin CH, Chen HC, Hwang JJ, Lai MS. Effectiveness and safety of extracranial carotid stent placement: a nationwide self-controlled case-series study. J Formos Med Assoc 2014; 114:274-81. [PMID: 24928418 DOI: 10.1016/j.jfma.2014.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 04/03/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Carotid angioplasty and stent (CAS) placement has emerged as an attractive revascularization strategy for patients with internal carotid artery stenosis. However, the effectiveness and safety of CAS were not fully evaluated, mainly because of methodological difficulties in finding an appropriate comparison group. METHODS Patients who underwent CAS were identified from Taiwan's National Health Insurance claims database between 2005 and 2008. The incidence rate of ischemic stroke after CAS was compared with that of the year prior to the procedure using a self-controlled case series analysis and a conditional Poisson regression model. Logistic regression was conducted to identify factors associated with poor outcome. RESULTS A total of 1258 patients who had undergone CAS were included, and 73 cases (5.8%) of death or ischemic stroke occurred during the index hospitalization. Within 1 year after CAS, 74 patients died and 80 experienced an ischemic stroke. Of the 1184 patients who were followed for 360 days, the rate ratio for ischemic stroke decreased to 0.21 (95% CI: 0.08-0.51) between 31 and 180 days, and 0.10 (95% CI: 0.03-0.32) between 181 and 360 days. Statin therapy was associated with a reduced risk of death or ischemic stroke in the 1(st) month (odds ratio of 0.53; 95% CI: 0.32-0.90). Conversely, the use of nonsteroidal anti-inflammatory agents, possibly histamine-2 receptor blockers, and CAS performed by low-volume operators were associated with a twofold increased risk. CONCLUSION CAS reduced the long-term risk for ischemic stroke. Self-controlled case series analysis might be an appropriate design for evaluating device safety and effectiveness.
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Affiliation(s)
- Chia-Hsuin Chang
- Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Jou-Wei Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan
| | - Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsi-Chieh Chen
- Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Juey-Jen Hwang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Mei-Shu Lai
- Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Wang KL, Wu CH, Wang KF, Chang CC, Chen LC, Lu TM, Lin SJ, Chiang CE. The association between low-density lipoprotein cholesterol goal attainment, physician and patient attitudes and perceptions, and healthcare policy. J Atheroscler Thromb 2014; 21:1044-54. [PMID: 24882620 DOI: 10.5551/jat.24158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Withholding effective treatment is clinically prevalent. The CEntralized Pan-Asian survey on tHE Under-treatment of hypercholeSterolemia (CEPHEUS-PA) indicated suboptimal low-density lipoprotein cholesterol (LDL-C) goal attainment in Taiwan, which may be attributable to clinical inertia. We herein analyzed the Taiwanese cohort in the CEPHEUS-PA to identify key elements regarding clinical inertia and unsatisfactory LDL-C control. METHODS A questionnaire regarding the attitudes and perceptions for each physician and patient was included in the CEPHEUS-PA. Physicians completed the physician questionnaire before enrolling patients, who completed the patient questionnaire before the assessment. RESULTS The National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guideline was used by 81.8% of physicians to establish the individual therapeutic targets; 50.2% of patients failed to take medications persistently. Regarding perceptions to hypercholesterolemia management, 75.9% of physicians were confident of having a sufficient number of patients at cholesterol targets; 80.2% and 65.9% of patients felt satisfied and motivated, respectively, but 46.0% had no strong feeling. The healthcare reimbursement policy used for treatment guidance was a significant determinant for LDL-C goal attainment (OR=0.32, 95% CI: 0.15-0.69, P=0.006) in addition to patient compliance. Low patient involvement indexed by having no strong feeling was associated with poor LDL-C control (OR=0.73, 95% CI: 0.56-0.95, P=0.020). CONCLUSIONS The referenced healthcare reimbursement policy, poor patient compliance, and low patient involvement with hypercholesterolemia management were associated with failure of LDL-C control. Our findings highlight the need to overcome those barriers to improve the under-treatment of hypercholesterolemia.
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Affiliation(s)
- Kang-Ling Wang
- Division of Cardiology, Taipei Veterans General Hospital
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Jameson K, Zhang Q, Zhao C, Ramey DR, Tershakovec AM, Gutkin SW, Marrett E. Total and low-density lipoprotein cholesterol in high-risk patients treated with atorvastatin monotherapy in the United Kingdom: analysis of a primary-care database. Curr Med Res Opin 2014; 30:655-65. [PMID: 24495126 DOI: 10.1185/03007995.2014.890926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE British clinical guidelines recommend statins as first-line lipid-modifying treatment (LMT) for patients at high risk of cardiovascular disease (CVD). We undertook an observational study to assess total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels in high-risk patients who were treated with atorvastatin monotherapy by UK general practitioners. METHODS This retrospective database study included patients with a prescription for atorvastatin monotherapy between November 30, 2008, and November 30, 2011, with the index date defined as the first atorvastatin prescription during this period. Eligible high-risk patients with evidence of coronary heart disease (CHD), atherosclerotic vascular disease (AVD), diabetes mellitus (DM), or familial hypercholesterolemia (FH) were required to have ≥1 TC and LDL-C measurement between 3 and 12 months after the index date, and continuous enrollment 1 year before and 1 year after the index date. Cholesterol levels were assessed using the National Institute for Health and Care Excellence (NICE) guidelines: TC <4.0 mmol/L or LDL-C <2.0 mmol/L. RESULTS Of 2999 high-risk patients (60.2% men; mean [SD] age = 67.9 [10.6] years) meeting selection criteria, 23.9% 28.2%, 36.2%, and 11.6% received prescriptions for atorvastatin 10, 20, 40, and 80 mg, respectively (percentages do not sum to 100 because of rounding). Across all doses, the mean (SD) follow-up TC was 4.08 (0.80) mmol/L and LDL-C 2.08 (0.65) mmol/L. A large proportion of patients (88.8%) had TC < 5.0 mmol/L. However, only 45.8% had TC < 4.0 mmol/L, and 46.5% had LDL-C < 2.0 mmol/L. Although a larger proportion of patients with CHD/AVD + DM reached guideline-recommended lipid levels, only 63.7% of such patients had TC < 4.0 or LDL-C < 2.0 mmol/L, which are the current targets for this subgroup as recommended by NICE. CONCLUSIONS Less than half of UK high-CVD-risk patients receiving atorvastatin monotherapy achieved guideline-recommended treatment targets for TC, and less than two-thirds of patients with CHD/AVD + DM had values below TC (4.0 mmol/L) or LDL-C (2.0 mmol/L) targets. More effective lipid-lowering strategies may be warranted to optimize cholesterol lowering and target attainment in high-risk patients. Limitations of this study include its retrospective, observational nature.
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Affiliation(s)
- Kevin Jameson
- Merck Sharp & Dohme Ltd, Hoddesdon , Hertfordshire , UK
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Prevalence of Dyslipidemia and Management in the Thai Population, National Health Examination Survey IV, 2009. J Lipids 2014; 2014:249584. [PMID: 24800083 PMCID: PMC3985300 DOI: 10.1155/2014/249584] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/25/2014] [Indexed: 11/17/2022] Open
Abstract
This study determined the prevalence and management of dyslipidemia in Thai adults using data from the Thai National Health Examination Survey IV in 2009. Dyslipidemia was defined based on the Third Adult Treatment Panel guidelines. A total of 19,021 adults aged 20 yr and over were included. Mean (SE) levels of total cholesterol, HDL-C, LDL-C, and triglycerides were 206.4 (1.03), 46.9 (0.34), 128.7 (1.09), and 131.4 (2.20) mg/dL, respectively. Prevalence of high LDL-C, low HDL-C, and high triglycerides were 29.6 %, 47.1 %, and 38.6%, respectively. Compared with individuals in the north and northeast, residents in Bangkok and Central region had significant higher levels of LDL-C but lower level of HDL-C. Triglyceride level was the highest in the northeast residents. Overall, 66.5% of Thais had some forms of dyslipidemia. Awareness and treatment of high LDL-C among those with high LDL-C were 17.8% and 11.7%, respectively. Among individuals aware of high LDL-C, those at highest CHD risk compared with those at low risk had higher percentage of treatment (73.1% versus 51.7%, resp.) but lower percentage of control at goal (32.9% versus 76.4%, resp.). Various forms of dyslipidemia are common in Thai adults, with a low level of awareness and treatment of high LDL-C.
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Wang KL, Liu CJ, Chao TF, Chen SJ, Wu CH, Huang CM, Chang CC, Wang KF, Chen TJ, Lin SJ, Chiang CE. Risk of new-onset diabetes mellitus versus reduction in cardiovascular events with statin therapy. Am J Cardiol 2014; 113:631-6. [PMID: 24360773 DOI: 10.1016/j.amjcard.2013.10.043] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/29/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
The Food and Drug Administration recently updated the safety warning concerning the association between statin therapy and new-onset diabetes mellitus (NODM). For prediabetes, little information is available for statins on cardiovascular outcome reduction and diabetogenic consequences. This study aimed to examine the risk of NODM and the reduction of cardiovascular events and death (MACE) after statin therapy in the prediabetic subjects. The medical and pharmacy claims of the prediabetic beneficiaries were retrieved from Taiwan National Health Insurance research database. The occurrence of NODM, MACE, and morbidity indexed by hospitalizations and emergency visits was ascertained by ambulatory and inpatient database. A propensity score-matched model was constructed for statin users and nonusers. During follow-up (4.1 ± 2.5 years), NODM and MACE occurred in 23.5% and 16.7%, respectively, of nonusers and 28.5% and 12.0%, respectively, of users. Statin therapy was associated with a greater risk of NODM (hazard ratio 1.20, 95% confidence interval 1.08 to 1.32) and less risk of MACE (hazard ratio 0.70, 95% confidence interval 0.61 to 0.80), both in dose-dependent fashions. The earlier and more persistent use correlated with the greater increase in risk of NODM offset by the proportionally larger reduction in MACE. Furthermore, the early persistent users had the lowest rate of hospitalizations and emergency visits. In conclusion, our findings suggested that the relation between NODM and therapeutic advantages of statins was parallel in the prediabetic population. Treatment benefits outweighed diabetic consequences in subjects receiving the earlier and more persistent treatment.
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Khoo CM, Tan MLS, Wu Y, Wai DCH, Subramaniam T, Tai ES, Lee J. Prevalence and Control of Hypercholesterolaemia as Defi ned by NCEP-ATPIII Guidelines and Predictors of LDL-C Goal Attainment in a Multi-Ethnic Asian Population. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2013. [DOI: 10.47102/annals-acadmedsg.v42n8p379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Introduction: Few studies in Asia have assessed the burden of hypercholesterolaemia based on the global cardiovascular risk assessment. This study determines the burden of hypercholesterolaemia in an Asian population based on the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII) guidelines, and examines predictors of low-density lipoprotein cholestrol (LDL-C) goal attainment. Materials and Methods: Five thousand and eighty-three Chinese, Malays and Asian-Indians living in Singapore were assigned to coronary heart disease (CHD)-risk category based on the NCEP-ATPIII guidelines. Awareness, treatment and control of hypercholesterolaemia based on risk-specific LDL-C goal were determined, including the use of lipid-lowering therapy (LLT). Cox-regression models were used to identify predictors of LDL-C above goal among those who were aware and unaware of hypercholesterolaemia. Results: One thousand fi ve hundred and sixty-eight (30.8%) participants were aware of hypercholesterolaemia and 877 (17.3%) were newly diagnosed (unaware). For those who were aware, 39.3% participants received LLT. Among those with 2 risk factors, only 59.7% attained LDL-C goal. The majority of them were taking statin monotherapy, and the median dose of statins was similar across all CHD risk categories. Among participants with 2 risk factors and not receiving LLT, 34.1% would require LLT. Malays or Asian-Indians, higher CHD risk category, increasing body mass index (BMI), current smoking and lower education status were associated with higher risk of LDL-C above goal. Being on LLT reduced the risk of having LDL-C above goal. Conclusion: The burden of hypercholesterolaemia is high in this multi-ethnic population especially those in the higher CHD risk categories, and might be partly contributed by inadequate titration of statins therapy. Raising awareness of hypercholesterolaemia, appropriate LLT initiation and titration, weight management and smoking cessation may improve LDL-C goal attainment in this population.
Key words: Asians, Awareness, Cholesterol, Goal attainment, Prevalence ratio, Treatment
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Affiliation(s)
- Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Maudrene LS Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yi Wu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | - E Shyong Tai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeannette Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Contemporary management and attainment of cholesterol targets for patients with dyslipidemia in China. PLoS One 2013; 8:e47681. [PMID: 23593110 PMCID: PMC3621908 DOI: 10.1371/journal.pone.0047681] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 09/17/2012] [Indexed: 11/19/2022] Open
Abstract
AIMS It is well-established that lipid disorder is an important cardiovascular risk factor, and failure to reach optimal lipid levels significantly contributes to the residual cardiovascular risks. However, limited information is available on the management and the attainment of recommended cholesterol targets in real-world practice in China. METHODS AND RESULTS A nationally representative sample of 12,040 patients with dyslipidemia from 19 provinces and 84 hospitals across China were consecutively enrolled in this survey. Risk stratification and individual cholesterol target was established for all participants. This survey identified a high-risk cohort, with over 50% of patients had hypertension, 37.5% had coronary artery disease, and more than 30% had peripheral artery disease. Thirty-nine percent of all participants received lipid lowering medications. And the majority of them (94.5%) had statins (42.5% with atorvastatin, 29.0% with simvastatin, and 15.2% with rosuvastatin). However, the overall attainment for low-density lipoprotein cholesterol (LDL-C) target is low (25.8%), especially, in female (22.2%), and in patients with increased body mass index (BMI) (38.3% for BMI<18.5, 28.1% for BMI 18.5-24.9, 26.0% for BMI 25.0-29.9, and 17.4% for BMI ≥ 30, P<0.0001). Subgroup analysis also showed the attainment is significantly lower in patients who were stratified into high (19.9%) and very high (21.1%) risk category. In logistic regression analysis, eight factors (BMI, gender, coronary artery disease, systolic and diastolic blood pressure, hypertension, family history of premature coronary artery disease and current smoking) were identified as independent predictors of LDL-C attainment. CONCLUSIONS Despite the proven benefits of lipid-lowering therapies, current management of dyslipidemia continues to be unsatisfied. A considerable proportion of patients failed to achieve guideline-recommended targets in China, and this apparent treatment gap was more pronounced among patients with increased BMI, higher risk stratification and women.
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Hsu TY, Chirovsky D, Moy FM, Ambegaonkar BM. Attainment of Goal and Normalized Lipid Levels With Lipid-Modifying Therapy in Malaysia. Clin Ther 2013; 35:450-60. [DOI: 10.1016/j.clinthera.2013.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/23/2013] [Accepted: 02/06/2013] [Indexed: 12/15/2022]
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Chin CW, Gao F, Le T, Tan R. Lipid goal attainment and prescription behavior in asian patients with acute coronary syndromes: experience from a tertiary hospital. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2013; 7:51-7. [PMID: 23533099 PMCID: PMC3603384 DOI: 10.4137/cmc.s11488] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lipid goal attainment studies in Asian patients with acute coronary syndrome (ACS) are limited. The objectives of this study were to determine low-density lipoprotein cholesterol (LDL-C) goal attainment rate at 4 months, and to examine prescription behavior influencing lipid goal attainment in Asian patients with ACS. A retrospective analysis of 267 patients with ACS was performed. The mean follow-up duration was 41.2±10.7 months. LDL-C goal attainment rate was highest at 4 months (36.7%) but declined progressively throughout follow-up. More than 85% of patients were discharged with equipotent statin dose of 2 (equivalent to simvastatin 20 mg) or less. In patients who did not attain LDL-C goals, the statin dose remained low throughout follow-up because of a lack in responsive dose titration. Aggressive lipid-lowering therapy should be initiated early to improve goal attainment in these high-risk patients.
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Affiliation(s)
- Calvin W Chin
- Department of Cardiology, National Heart Center Singapore, Singapore
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Jones PH, Nair R, Thakker KM. Prevalence of dyslipidemia and lipid goal attainment in statin-treated subjects from 3 data sources: a retrospective analysis. J Am Heart Assoc 2012; 1:e001800. [PMID: 23316314 PMCID: PMC3540660 DOI: 10.1161/jaha.112.001800] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 08/02/2012] [Indexed: 01/10/2023]
Abstract
Background Evidence-based randomized clinical trials have shown significant benefit of statin treatment with regard to cardiovascular disease. In anticipation of the National Cholesterol Education Program Adult Treatment Panel IV guidelines, we wanted to assess the current state of lipid goal attainment in the high-risk secondary prevention population in the United States. The objectives of the study were to estimate the proportion of high-risk patients treated with statin monotherapy who achieved Adult Treatment Panel III–recommended low-density lipoprotein cholesterol (LDL-C) goals (<100 mg/dL; optional <70 mg/dL) as well as non–high-density lipoprotein cholesterol goals (<130 mg/dL; optional <100 mg/dL). Methods and Results This is a cross-sectional, retrospective study of 3 data sources: electronic medical records (2003–September 2010), administrative claims data (2003–2010), and National Health and Nutrition Examination Survey data (2007–2008). High-risk patients (≥18 years of age) were defined as those with a history of coronary heart disease or coronary heart disease risk equivalent who had the latest complete lipid panel measurement and had been treated with statin monotherapy for >90 days at the time of the lipid panel. Cardiovascular disease, coronary heart disease, and coronary heart disease risk equivalents were defined on the basis of availability, specific to each data source. Across the 3 data sources, 20% to 26% of high-risk patients treated with statin monotherapy for >90 days had LDL-C <70 mg/dL, and 67% to 77% had LDL-C <100 mg/dL. The percentages of those attaining both LDL-C goals and non–high-density lipoprotein cholesterol goals were quantitatively smaller (13.5% to 19.0% and 46% to 70%). Conclusions Across the 3 data sources, there was consistency in the proportion of high-risk patients treated with statin monotherapy who were at LDL-C goal. A significant number of these statin-treated patients had additional dyslipidemias.
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Registry of Lipid Control and the Use of Lipid-lowering Drugs for Secondary Prevention of Cardiovascular Events in Patients with Established Atherosclerotic Disease in Taiwan: Rationality and Methods. INT J GERONTOL 2012. [DOI: 10.1016/j.ijge.2012.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Penfornis A, Baleydier A, Clavel T, Picard S. LDL-cholesterol target values and actual values in patients with type 2 diabetes (T2D) uncontrolled on oral antidiabetic monotherapy: the lipid results of the French ESCALADE survey. ANNALES D'ENDOCRINOLOGIE 2012; 73:503-9. [PMID: 23122577 DOI: 10.1016/j.ando.2012.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
AIM While new European guidelines have recommended much lower LDL-c target values than current 2005 French HAS guidelines, it appears that even those ones are not widely implemented. This lipid-side of the ESCALADE study was designed to determine the LDL-c target values of GPs, diabetologists (DIABs) and cardiologists (CARDIOs) and the consistency of actual values in patients with type 2 diabetes (T2D) uncontrolled on antidiabetic monotherapy. METHODS ESCALADE was a national multicentre, observational, descriptive, transversal survey. One thousand and three hundred GPs and 350 specialists (DIABs and CARDIOs) agreed to include respectively three and four patients each. For each patient, the physician had to set the LDL-c target value that was compared to the calculated HAS target value. The actual LDL-c value was recorded and compared to those target values. RESULTS A total of 412 GPs, 137 DIABs and 27 CARDIOs included respectively 699, 364 and 66 patients. Among them 19.6% had cardiovascular disease (CVD) and 56.9% were on lipid-lowering therapy (LLT). The physician's target value was in concordance with HAS value in 37.3% (GPs), 35.4% (DIABs) and 57.4% (CARDIOs) of the cases. Physicians overestimated the risk in respectively 42.7%, 54.1% and 21.3%. However, very high risk was underestimated in respectively 38.1%, 22.0% and 25.6% of the patients and the actual LDL-c value was in the target range (<100mg/dL) for only 28% of the very high-risk patients. CONCLUSION Physicians tend to overestimate the CVD risk in patients with T2D and set lower LDL-c target values than HAS calculated values. Nevertheless, patients with a very high risk are largely under-treated.
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Affiliation(s)
- Alfred Penfornis
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean Minjoz Hospital, EA 3920, University of Franche-Comté, 25030 Besançon cedex, France.
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Wang KL, Liu CJ, Chao TF, Huang CM, Wu CH, Chen SJ, Chen TJ, Lin SJ, Chiang CE. Statins, risk of diabetes, and implications on outcomes in the general population. J Am Coll Cardiol 2012; 60:1231-8. [PMID: 22884288 DOI: 10.1016/j.jacc.2012.05.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 05/10/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study aimed to evaluate the association of statin exposure and incident diabetes, and subsequent outcomes in the general population. BACKGROUND Cardiovascular events as consequences of atherosclerosis and diabetes are reduced by statins. However, statins are associated with excessive risk of diabetes occurrence according to clinical trial analyses. From daily-practice perspectives, it remains unclear whether statin use increases risk; prognoses of diabetes after exposure require further clarification. METHODS From Taiwan National Health Insurance beneficiaries age ≥45 years (men) and ≥55 years (women) before 2004, subjects continuously treated with statins ≥30 days during 2000 to 2003 and nonusers before 2004 were identified. Among nondiabetic individuals at the cohort entry, controls were matched to statin users on a 4:1 ratio by age, sex, atherosclerotic comorbidities, and year of their entry. Outcomes as diabetes, major adverse cardiovascular events (MACE, the composite of myocardial infarction and ischemic stroke), and in-hospital deaths were assessed. RESULTS Over a median of 7.2 years, annual rates of diabetes were significantly higher in statin users (2.4% vs. 2.1%, p < 0.001), whereas MACE (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.68 to 0.98 for myocardial infarction; HR: 0.94; 95% CI: 0.86 to 1.03 for ischemic stroke; HR: 0.91; 95% CI: 0.84 to 0.99 for MACE]) and in-hospital mortality (HR: 0.61; 95% CI: 0.55 to 0.67]) were less. The risk-benefit analyses suggested that statin treatment was favorable in high-risk (HR: 0.89; 95% CI: 0.83 to 0.95) and secondary prevention (HR: 0.89; 95% CI: 0.83 to 0.96) populations. Among diabetic patients, prior statin use was associated with fewer MACE (HR: 0.75; 95% CI: 0.59 to 0.97). In-hospital deaths were similar in statin-related diabetes among high-risk (HR: 1.11; 95% CI: 0.83 to 1.49) and secondary prevention (HR: 1.08; 95% CI: 0.79 to 1.47) subjects compared with nondiabetic controls. CONCLUSIONS Risk of diabetes was increased after statins, but outcomes were favorable.
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Affiliation(s)
- Kang-Ling Wang
- Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
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49
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Zhang R, Zhao L, Liang L, Xie G, Wu Y. Factors explaining the gender disparity in lipid-lowering treatment goal attainment rate in Chinese patients with statin therapy. Lipids Health Dis 2012; 11:59. [PMID: 22642757 PMCID: PMC3697899 DOI: 10.1186/1476-511x-11-59] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 05/29/2012] [Indexed: 11/10/2022] Open
Abstract
Background The lipid-lowering treatment goal attainment rate is lower for women than for
men among Chinese patients, but the reasons for this disparity have not been
fully explored yet. Objectives To elucidate the potential factors and the significance of their
contributions towards the observed discrepancy in lipid-lowering treatment
goal attainment rates between Chinese women and men. Methods We used data from 1808 patients from 21 tertiary and 6 secondary hospitals in
China who received and maintained statin therapy treatment for at least
2 months. Lipid-lowering treatment goal attainment was defined as
low-density lipoprotein cholesterol (LDL- C) reaching the treatment targets
recommended by the Chinese Guidelines on Prevention and Control of
Dyslipidemia in Adults. Logistic Regression was used to explore possible
factors associated with gender disparity in goal attainment rates, and to
what extent each factor contributes. Results A total of 674 women and 1134 men were enrolled in the study. Women had a
significantly lower LDL-C goal attainment rate than that of men (46.0% vs
53.8%, P = 0.002), particularly in high and very high CVD risk
groups. Among high and very high risk patients, approximately 35%, 7%, 5%,
and 5% of gender disparity in LDL-C goal attainment rate was attributable to
the gender difference in baseline LDL-C level, cardiovascular co-morbidities
and associated risk factors, socioeconomic status, and the dosage of statin
treatment, respectively. Approximately 50% of the gender disparity remained
unexplained by these factors. Conclusions Although nearly half of the gender disparity in lipid-lowering treatment goal
attainment rate can be explained by the gender differences in baseline lipid
level, socioeconomic status, cardiovascular co-morbidities and associated
risk factors, and the dosage of statin in high and very high CVD risk
patients, the other half of the gender disparity remains unexplained and
requires further study to fully understand what other factors are at
play.
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Affiliation(s)
- Rui Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, 100191, China
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Abstract
Historically the efficacy and safety of statins has mostly been studied in western populations. Few such studies have been carried out in Asians until recent years. These studies revealed interesting similarities and differences for statin use between Asians and Caucasians. One clinically important question subsequently raised is whether Asians need lower statin doses compared with Caucasians. Many practicing physicians believe that statin doses are lower in Asians because of the generally lower bodyweight and BMI. Whether this belief is based on sound scientific evidence needs to be reviewed. Furthermore, since the decision of optimal dose is based on both efficacy and safety, both of which may be impacted by genetic factors, one may ask whether pharmacogenetics plays a role in the dose difference, if such a difference exists. There is a clinical need to critically and comprehensively article the literature to answer these questions, and summarize future directions of research in the field. This article serves the above purpose.
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Affiliation(s)
- Ping Wang
- Department of Pathology & Laboratory Medicine, The Methodist Hospital & The Methodist Hospital Research Institute, Houston, TX 77030, USA.
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