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Villar-Taibo R, Fernández-Rodríguez E, Tejera-Pérez C, Díaz-Ortega C, Sánchez-Sobrino P, Palmeiro-Carballeira R, Rodríguez-Novo N, Rodríguez-Carnero G, Pinal-Osorio I, Cotovad-Bellas L, Díaz-Trastoy O, Mantiñán-Gil B, Álvarez-Castro P, Andújar Plata P, Seoane-Cruz I, Prieto-Tenreiro A, Argüeso Armesto R, Fernández-Pombo A, Sánchez-Bao A, Vidal-Casariego A. GALIPDIA study: Reaching lipid targets in a population with type 2 diabetes (T2DM) from the Northwest of Spain. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2023; 70:29-38. [PMID: 36764745 DOI: 10.1016/j.endien.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/27/2022] [Indexed: 02/11/2023]
Abstract
AIM To assess the degree of compliance with the European ESC/EAS 2016 and 2019 dyslipidaemia guidelines in patients with type 2 diabetes mellitus (T2DM). METHODS Multicentre retrospective cross-sectional study, conducted in 380 adults with T2DM and dyslipidaemia in 7 Spanish health areas. INCLUSION CRITERIA minimum follow-up of one year in Endocrinology Units, at least one visit in 2020 and a lipid profile measurement in the last 3 months. EXCLUSION CRITERIA familial hypercholesterolaemia, recent hospitalisation, active oncological pathology and dialysis. RESULTS According to the 2016 and 2019 guidelines the majority of patients were classified as being at very high cardiovascular risk (86.8% vs. 72.1%, respectively). LDL-c compliance was adequate in 62.1% of patients according to the 2016 guidelines and 39.7% according to the 2019 guidelines (p<0.001). Clinical conditions such as history of cardiovascular disease and therapy-related aspects (use of statins, especially high-potency statins, combination therapies and good adherence) were significantly associated with greater achievement of lipid targets. CONCLUSION There is a discrepancy between dyslipidaemia guideline recommendations and the reality of lipid control in patients with T2DM, despite most of these patients being at very high cardiovascular risk. Strategies to optimise lipid-lowering treatments need to be implemented.
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Affiliation(s)
- Rocío Villar-Taibo
- Division of Endocrinology, University Clinical Hospital of Santiago de Compostela, C/ Choupana, s/n, 15706 Santiago de Compostela, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Eva Fernández-Rodríguez
- Division of Endocrinology, University Clinical Hospital of Ourense, C/ Ramon Puga Noguerol, 54, 32005 Ourense, Spain
| | - Cristina Tejera-Pérez
- Division of Endocrinology, University Clinical Hospital of Ferrol, Avda. de la Residencia S/N, 15405 Ferrol, A Coruña, Spain; Epigenomics in Endocrinology and Nutrition Group, Instituto de Investigacion Sanitaria de Santiago (IDIS), C/ Choupana, s/n, 15706 Santiago de Compostela, Spain.
| | - Carmen Díaz-Ortega
- Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Division of Endocrinology, University Clinical Hospital of Ourense, C/ Ramon Puga Noguerol, 54, 32005 Ourense, Spain
| | - Paula Sánchez-Sobrino
- Division of Endocrinology, University Clinical Hospital of Montecelo, C/ Mourente, s/n, 36071 Pontevedra, Spain
| | - Regina Palmeiro-Carballeira
- Division of Endocrinology, University Clinical Hospital of Vigo, Estrada de Clara Campoamor, 341, 36213 Vigo, Pontevedra, Spain
| | - Nazareth Rodríguez-Novo
- Division of Endocrinology, University Clinical Hospital of Lugo, C/ Doctor Ulises Romero, 1, 27003 Lugo, Spain
| | - Gemma Rodríguez-Carnero
- Division of Endocrinology, University Clinical Hospital of Santiago de Compostela, C/ Choupana, s/n, 15706 Santiago de Compostela, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Iria Pinal-Osorio
- Division of Endocrinology, University Clinical Hospital of Ourense, C/ Ramon Puga Noguerol, 54, 32005 Ourense, Spain
| | - Laura Cotovad-Bellas
- Division of Endocrinology, University Clinical Hospital of Ferrol, Avda. de la Residencia S/N, 15405 Ferrol, A Coruña, Spain
| | - Olaia Díaz-Trastoy
- Division of Endocrinology, University Clinical Hospital of Montecelo, C/ Mourente, s/n, 36071 Pontevedra, Spain
| | - Beatriz Mantiñán-Gil
- Division of Endocrinology, University Clinical Hospital of Vigo, Estrada de Clara Campoamor, 341, 36213 Vigo, Pontevedra, Spain
| | - Paula Álvarez-Castro
- Division of Endocrinology, University Clinical Hospital of Lugo, C/ Doctor Ulises Romero, 1, 27003 Lugo, Spain
| | - Paula Andújar Plata
- Division of Endocrinology, University Clinical Hospital of Santiago de Compostela, C/ Choupana, s/n, 15706 Santiago de Compostela, Spain
| | - Inés Seoane-Cruz
- Division of Endocrinology, University Clinical Hospital of Ourense, C/ Ramon Puga Noguerol, 54, 32005 Ourense, Spain
| | - Alma Prieto-Tenreiro
- Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Division of Endocrinology, University Clinical Hospital of Ferrol, Avda. de la Residencia S/N, 15405 Ferrol, A Coruña, Spain
| | - Rosa Argüeso Armesto
- Division of Endocrinology, University Clinical Hospital of Lugo, C/ Doctor Ulises Romero, 1, 27003 Lugo, Spain
| | - Antía Fernández-Pombo
- Division of Endocrinology, University Clinical Hospital of Santiago de Compostela, C/ Choupana, s/n, 15706 Santiago de Compostela, Spain; Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ana Sánchez-Bao
- Division of Endocrinology, University Clinical Hospital of Ferrol, Avda. de la Residencia S/N, 15405 Ferrol, A Coruña, Spain
| | - Alfonso Vidal-Casariego
- Division of Endocrinology, University Clinical Hospital of A Coruña, C/ Xubias de Arriba, 84, 15006 A Coruña, Spain
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Arutyunov GP, Arutyunov AG, Ageev FT, Fofanova TV. Use of digital technology tools to characterize adherence to prescription-grade omega-3 polyunsaturated fatty acid therapy in post-myocardial or hypertriglyceridemic patients: Primary results of the DIAPAsOn prospective observational study (Preprint). JMIR Cardio 2022; 6:e37490. [PMID: 35877173 PMCID: PMC9361151 DOI: 10.2196/37490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022] Open
Abstract
Background Maintaining sustained adherence to medication for optimal management of chronic noninfectious diseases, such as atherosclerotic vascular disease, is a well-documented therapeutic challenge. Objective The DIAPAsOn study was a 6-month, multicenter prospective observational study in the Russian Federation that examined adherence to a preparation of highly purified omega-3 polyunsaturated fatty acids (Omacor) in 2167 adult patients with a history of recent myocardial infarction or endogenous hypertriglyceridemia. Methods A feature of DIAPAsOn was the use of a bespoke electronic patient engagement and data collection system to monitor adherence. Adherence was also monitored by enquiry at clinic visits. A full description of the study’s aims and methods has appeared in JMIR Research Protocols. Results The net average reduction from baseline in both total and low-density lipoprotein cholesterol was approximately 1 mmol/L and the net average increase in high-density lipoprotein cholesterol was 0.2 (SD 0.53) mmol/L (P<.001 for all outcomes vs baseline). The mean triglyceride level was 3.0 (SD 1.3) mmol/L at visit 1, 2.0 (SD 0.9) mmol/L at visit 2, and 1.7 (SD 0.7) mmol/L at visit 3 (P<.001 for later visits vs visit 1). The percentage of patients with a triglyceride level <1.7 mmol/L rose from 13.1% (282/2151) at baseline to 54% (1028/1905) at the end of the study. Digital reporting of adherence was registered by 8.3% (180/2167) of patients; average scores indicted poor adherence. However, a clinic-based enquiry suggested high levels of adherence. Data on health-related quality of life accrued from digitally engaged patients identified improvements among patients reporting high adherence to study treatment, but patient numbers were small. Conclusions The lipid and lipoprotein findings indicate that Omacor had nominally favorable effects on the blood lipid profile. Less than 10% of patients enrolled in DIAPAsOn used the bespoke digital platform piloted in the study, and the level of self-reported adherence to medication by these patients was also low. Reasons for this low uptake and adherence are unclear. Better adherence was recorded in clinical reports. Trial Registration ClinicalTrials.gov NCT03415152; https://clinicaltrials.gov/ct2/show/NCT03415152
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Affiliation(s)
- Gregory P Arutyunov
- Department of Internal Medicine, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Alexander G Arutyunov
- Department of Internal Medicine, Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Fail T Ageev
- Department of Outpatient Medical and Diagnostic Technologies of the Research Institute of Cardiology named after A.L. Myasnikov, Federal State Budgetary Institution National Medical Research Center of Cardiology named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Tatiana V Fofanova
- Department of Outpatient Medical and Diagnostic Technologies of the Research Institute of Cardiology named after A.L. Myasnikov, Federal State Budgetary Institution National Medical Research Center of Cardiology named after Academician E.I. Chazov, Ministry of Health of the Russian Federation, Moscow, Russian Federation
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Gong Y, Li X, Ma X, Yu H, Li Y, Chen J, Zhang G, Wang B, Qi X, Meng H, Wang X, Mu J, Hu X, Wang J, Liu S, Liu G, Yang Z, Zhou Y, Kong X, Yan Y, Wang C, Wang JA, Wang L, Fu G, Wei L, Peng D, Zhang S, Li R, Mao A, Bian R, Tang W, Ran Y, Jiang J, Huo Y. Lipid goal attainment in post-acute coronary syndrome patients in China: Results from the 6-month real-world dyslipidemia international study II. Clin Cardiol 2021; 44:1575-1585. [PMID: 34651329 PMCID: PMC8571548 DOI: 10.1002/clc.23725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/20/2021] [Accepted: 09/03/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dyslipidemia International Study II (DYSIS II)-China was conducted to determine the low-density lipoprotein cholesterol (LDL-C) goal (<1.8 mmol/L) attainment rate in patients with post-acute coronary syndrome (ACS). HYPOTHESIS Compliance with treatment guideline recommendations improves the LDL-C goal attainment rate in post-ACS patients. METHODS This multicenter prospective observational study conducted at 28 tertiary hospitals determined the LDL-C goal attainment rates at admission and 6-month follow-up in patients on lipid-lowering treatment (LLT) for ≥3 months and those not on LLT (LLT-naive or off LLT for ≥3 months) at admission. Predictors of goal attainment at 6 months were identified using multivariate logistic regression. RESULTS The LDL-C goal attainment rate at admission in 1102/1103 enrolled patients was 17.1%; it was 41.2% among 752 patients with available lipid results at 6 months. The distance to goal was 0.7 mmol/L at 6 months. Statin monotherapy was the most prescribed LLT. Only 7.7% of patients were receiving statin + ezetimibe and 8.4% of patients were receiving an atorvastatin-equivalent dose of ≥40 mg/day at 6 months. Being male (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1-2.6) and undergoing percutaneous coronary intervention during index hospitalization (OR 1.5, 95% CI 1.1 to 2.1) were the independent predictors for LDL-C goal attainment. CONCLUSIONS This real-world DYSIS II study in China reports a low LDL-C goal attainment rate in post-ACS patients even after 6 months of LLT. Lack of intensification of statin therapy and underutilization of combinations suggest gaps between real-world treatment practices and guideline recommendations.
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Arutyunov GP, Arutyunov AG, Ageev FT, Fofanova TV. Digital Technology Tools to Examine Patient Adherence to a Prescription-Only Omega-3 Polyunsaturated Fatty Acid Therapy To Mitigate Cardiovascular Risk: Protocol for a Prospective Observational Study and Preliminary Demographic Analysis. JMIR Res Protoc 2021; 10:e29061. [PMID: 34459746 PMCID: PMC8438613 DOI: 10.2196/29061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/05/2021] [Accepted: 06/30/2021] [Indexed: 12/19/2022] Open
Abstract
Background Sustained adherence and persistence with prescription medications is considered essential to achieve maximal treatment benefit for patients with major chronic, noncommunicable diseases such as hyperlipidemia and lipid-associated cardiovascular disease. It is widely documented, however, that many patients with these conditions have poor long-term adherence to their treatments. The population of Russia is affected by poor adherence in the same ways as populations elsewhere and continues to have high rates of cardiovascular disease. Objective The purpose of this study was to examine patient adherence to a prescription-only preparation of highly purified omega-3 polyunsaturated fatty acids (1.2 to 1 eicosapentaenoic acid to docosahexaenoic ratio, 90% purity) in a large sample of patients at risk for cardiovascular diseases using digital technology to monitor patient behavior and as an outreach facility for patient education and engagement. Methods We conducted a 6-month prospective observational study (DIAPAsOn) at >100 centers in the Russian Federation. A bespoke electronic data capture and patient engagement system were developed with a well-established Russian technology supplier that enables information obtained during clinic visits to be supplemented by remote patient self-reporting. Other aspects of the program included raising patients' awareness about their condition via educational materials available in personal patient accounts in the electronic system. Results From an initial cohort of 3000 patients, a safety population of 2572 patients (age: mean 60 years) with an equal proportion of men and women has been characterized. There was widespread concomitant cardiovascular pathology and commensurate use of multiple classes of cardiovascular medication, notably lipid-modifying and antihypertensive drugs. The program was completed by 1975 patients, of whom 780 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for secondary prevention after myocardial infarction and 1195 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for hypertriglyceridemia. Data collection and analysis have been completed. Conclusions DIAPAsOn will provide insights into patient adherence with prescription-grade omega-3 polyunsaturated fatty acid therapy and perspectives on the role of mobile technology in monitoring and encouraging adherence to therapy.
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Affiliation(s)
- Gregory P Arutyunov
- Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | | | - Fail T Ageev
- National Medical Research Center for Cardiology, Moscow, Russian Federation
| | - Tatiana V Fofanova
- National Medical Research Center for Cardiology, Moscow, Russian Federation
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Hasan S, Naugler C, Decker J, Fung M, Morrin L, Campbell NRC, Anderson TJ. Laboratory reporting of framingham risk score increases statin prescriptions in at-risk patients. Clin Biochem 2021; 96:1-7. [PMID: 34197811 DOI: 10.1016/j.clinbiochem.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The under-utilization of cardiovascular preventative therapy with statins warrants novel interventions to optimize prescriptions in at-risk patients. We investigated the role of a laboratory generated Framingham Risk Score (FRS) provided to primary care clinicians in changing statin use in a primary care setting. METHODS Data was acquired from the electronic medical records of 1573 anonymized patients undergoing routine lipid testing. Follow-up statin use and low-density lipoprotein cholesterol levels were obtained for 2 years post intervention. FRS parameters were entered into a laboratory information system, and provided to ordering physicians along with the cholesterol profile and the appropriate current Canadian Dyslipidemia treatment recommendation in a single report. Statin prescription rates following the intervention were compared with historical use 6 months prior to the study. RESULTS A total of 1283 participants (mean age of 60 ± 11 years) had an FRS report and were considered for analysis. Two hundred individuals filled a statin prescription in the 6 months prior to their index lipid test, and an additional 84 filled a statin prescription following the intervention (42% increase). The relative and absolute increase in statin prescription was 47.3% and 13.6% in the high-risk group p < 0.001, 53.3% and 8.1% in the intermediate-risk group p < 0.001, and 17.0% and 1.42% in the low-risk group p = 0.008, respectively. CONCLUSION The use of the laboratory reported FRS was associated with a significant increase in the rate of statin prescription across all risk groups. The expansion of FRS reporting across other health regions would improve cardiovascular risk prevention.
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Affiliation(s)
- Sarah Hasan
- Department of Cardiac Sciences, Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Christopher Naugler
- O'Brien Institute of Public Health Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada; Department of Pathology and Laboratory Medicine, Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Jeffrey Decker
- Chinook Primary Care Network, Alberta Health Services, 817 4 Ave S #200, Lethbridge, AB T1J 0P3, Canada
| | - Marinda Fung
- Department of Cardiac Sciences, Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Louise Morrin
- Medicine and Digestive Health Strategic Clinical Networks, Alberta Health Services, Canada
| | - Norm R C Campbell
- Libin Cardiovascular Institute, Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada; O'Brien Institute of Public Health Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada; Department of Medicine, Physiology and Pharmacology and Community Health Sciences, Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Todd J Anderson
- Department of Cardiac Sciences, Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada.
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