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Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe: EURIKA, a cross-sectional observational study. BMC Cardiovasc Disord 2017. [PMID: 28623902 PMCID: PMC5473961 DOI: 10.1186/s12872-017-0591-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Atherogenic dyslipidemia is associated with poor cardiovascular outcomes, yet markers of this condition are often ignored in clinical practice. Here, we address a clear evidence gap by assessing the prevalence and treatment of two markers of atherogenic dyslipidemia: elevated triglyceride levels and low levels of high-density lipoprotein cholesterol. Methods This cross-sectional observational study assessed the prevalence of two atherogenic dyslipidemia markers, high triglyceride levels and low high-density lipoprotein cholesterol levels, in the study population from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; N = 7641; of whom 51.6% were female and 95.6% were White/Caucasian). The EURIKA population included European patients, aged at least 50 years with at least one cardiovascular risk factor but no history of cardiovascular disease. Results Over 20% of patients from the EURIKA population have either triglyceride or high-density lipoprotein cholesterol levels characteristic of atherogenic dyslipidemia. Furthermore, the proportions of patients with one of these markers were higher in subpopulations with type 2 diabetes mellitus or those already calculated to be at high risk of cardiovascular disease. Approximately 55% of the EURIKA population who have markers of atherogenic dyslipidemia are not receiving lipid-lowering therapy. Conclusions A considerable proportion of patients with at least one major cardiovascular risk factor in the primary cardiovascular disease prevention setting have markers of atherogenic dyslipidemia. The majority of these patients are not receiving optimal treatment, as specified in international guidelines, and thus their risk of developing cardiovascular disease is possibly underestimated. Trial registration The present study is registered with ClinicalTrials.gov (ID: NCT00882336). Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0591-5) contains supplementary material, which is available to authorized users.
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Halcox JP, Tubach F, Lopez-Garcia E, De Backer G, Borghi C, Dallongeville J, Guallar E, Medina J, Perk J, Sazova O, Sweet S, Roy C, Banegas JR, Rodriguez-Artalejo F. Low rates of both lipid-lowering therapy use and achievement of low-density lipoprotein cholesterol targets in individuals at high-risk for cardiovascular disease across Europe. PLoS One 2015; 10:e0115270. [PMID: 25692692 PMCID: PMC4333116 DOI: 10.1371/journal.pone.0115270] [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: 07/02/2014] [Accepted: 11/23/2014] [Indexed: 02/03/2023] Open
Abstract
AIMS To analyse the treatment and control of dyslipidaemia in patients at high and very high cardiovascular risk being treated for the primary prevention of cardiovascular disease (CVD) in Europe. METHODS AND RESULTS Data were assessed from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA, ClinicalTrials.gov identifier: NCT00882336), which included a randomly sampled population of primary CVD prevention patients from 12 European countries (n = 7641). Patients' 10-year risk of CVD-related mortality was calculated using the Systematic Coronary Risk Evaluation (SCORE) algorithm, identifying 5019 patients at high cardiovascular risk (SCORE ≥5% and/or receiving lipid-lowering therapy), and 2970 patients at very high cardiovascular risk (SCORE ≥10% or with diabetes mellitus). Among high-risk individuals, 65.3% were receiving lipid-lowering therapy, and 61.3% of treated patients had uncontrolled low-density lipoprotein cholesterol (LDL-C) levels (≥2.5 mmol/L). For very-high-risk patients (uncontrolled LDL-C levels defined as ≥1.8 mmol/L) these figures were 49.5% and 82.9%, respectively. Excess 10-year risk of CVD-related mortality (according to SCORE) attributable to lack of control of dyslipidaemia was estimated to be 0.72% and 1.61% among high-risk and very-high-risk patients, respectively. Among high-risk individuals with uncontrolled LDL-C levels, only 8.7% were receiving a high-intensity statin (atorvastatin ≥40 mg/day or rosuvastatin ≥20 mg/day). Among very-high-risk patients, this figure was 8.4%. CONCLUSIONS There is a considerable opportunity for improvement in rates of lipid-lowering therapy use and achievement of lipid-level targets in high-risk and very-high-risk patients being treated for primary CVD prevention in Europe.
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Affiliation(s)
- Julian P. Halcox
- Institute of Life Sciences 2, Swansea University College of Medicine, Swansea, United Kingdom
| | - Florence Tubach
- INSERM CIC-EC 1425 and Epidemiology and Clinical Research Department, Assistance Publique—Hôpitaux de Paris, Hôpital Bichat, Paris, France
- Univ Paris Diderot, Sorbonne Paris Cité, UMR 1123, Paris, France
| | - Esther Lopez-Garcia
- Department of Preventative Medicine and Public Health, Universidad Autónoma de Madrid IdiPaz and CIBERESP, Madrid, Spain
| | - Guy De Backer
- Department of Public Health, University of Ghent, Ghent, Belgium
| | - Claudio Borghi
- Department of Internal Medicine, Ageing and Clinical Nephrology, University of Bologna, Bologna, Italy
| | - Jean Dallongeville
- INSERM U 744, Institut Pasteur de Lille, Université Lille-Nord de France, Lille, France
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine and Welch Center of Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research, Madrid, Spain
| | - Jesús Medina
- Observational Research Centre, Global Medical Affairs, AstraZeneca Farmacéutica Spain, Madrid, Spain
| | - Joep Perk
- School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Ogün Sazova
- AstraZeneca Global Medical Affairs, London, United Kingdom
| | - Stephen Sweet
- Research Evaluation Unit, Oxford PharmaGenesis Ltd, Oxford, United Kingdom
| | - Carine Roy
- INSERM CIC-EC 1425 and Epidemiology and Clinical Research Department, Assistance Publique—Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - José R. Banegas
- Department of Preventative Medicine and Public Health, Universidad Autónoma de Madrid IdiPaz and CIBERESP, Madrid, Spain
| | - Fernando Rodriguez-Artalejo
- Department of Preventative Medicine and Public Health, Universidad Autónoma de Madrid IdiPaz and CIBERESP, Madrid, Spain
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Schuster H. The GALAXY Program: an update on studies investigating efficacy and tolerability of rosuvastatin for reducing cardiovascular risk. Expert Rev Cardiovasc Ther 2014; 5:177-93. [PMID: 17338663 DOI: 10.1586/14779072.5.2.177] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The GALAXY Program is a series of clinical studies investigating the efficacy and tolerability of rosuvastatin in line with the hypothesis that the statin with the greatest efficacy for improving the atherogenic lipid profile and beneficially modifying inflammatory markers will also slow progression of atherosclerosis and improve cardiovascular outcomes. Completed studies report that rosuvastatin is more effective than comparator statins in reducing low-density lipoprotein cholesterol, improving the lipid profile and enabling patients to achieve lipid goals, including revised, more stringent goals, even in high-risk patients. Studies have also reported that rosuvastatin can arrest and even regress atherosclerosis. Ongoing outcomes studies will determine whether these beneficial effects of rosuvastatin translate into reduced morbidity and mortality.
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Ardigò D, Vaccaro O, Cavalot F, Rivellese AA, Franzini L, Miccoli R, Patti L, Boemi M, Trovati M, Zavaroni I. Effectiveness of treat-to-target strategy for LDL-cholesterol control in type 2 diabetes: post-hoc analysis of data from the MIND.IT study. Eur J Prev Cardiol 2012; 21:456-63. [PMID: 23147277 DOI: 10.1177/2047487312467746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The paper presents a post-hoc analysis of the intensity of dyslipidaemia care operated in the first 2 years of Multiple-Intervention-in-type-2-Diabetes.ITaly (MIND.IT) study. DESIGN AND METHODS MIND.IT is a multicentric, randomized, two-parallel arm trial involving 1461 type 2 diabetic patients at high cardiovascular (CV) risk. The study compares the usual care (UC) of CV prevention with a multifactorial intensive care (IC) approach aiming at achieving target values for the main CV risk factors according to a step-wise treat-to-target approach. RESULTS Proportion of patients on target for low-density lipoprotein cholesterol (LDL-C) was about 10% at baseline and increased significantly more with IC than UC (43 vs. 27%; p < 0.001). However, the majority (57%) of patients, in this intended intensively treated cohort, failed to achieve the proposed target. Average LDL-C decreased from 144 ± 35 to 108 ± 31 mg/dl with IC and from 142 ± 28 to 118 ± 32 with UC (p-for-interaction <0.0001). IC was associated with a significantly greater increase in statin prescription and lower withdrawal from treatment than UC (43 vs. 11% and 28 vs. 61%, respectively; both p < 0.001). However, the new treatments were characterized in both groups by the use of low starting doses (≤ 10 mg of atorvastatin, equivalent dose in more than 90% of patients) without increase in case of missed target. CONCLUSIONS The application of a multifactorial treat-to-target intervention is associated with a significant improvement in LDL-C beyond usual practice. However, the change in LDL-C appears to be more related to an increased number of treated patients and a decreased treatment withdrawal than to a true treat-to-target approach.
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Athyros VG, Gossios TD, Katsiki N, Karagiannis A, Mikhailidis DP. The clinical benefit of implementing guidelines in cardiovascular disease prevention in real world settings. Arch Med Sci 2012; 8:6-10. [PMID: 22457666 PMCID: PMC3309428 DOI: 10.5114/aoms.2012.27272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 02/04/2012] [Accepted: 02/04/2012] [Indexed: 01/13/2023] Open
Affiliation(s)
- Vasilios G. Athyros
- 2 Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Thomas D. Gossios
- 1 Cardiology Clinic, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Niki Katsiki
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic) and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom
| | - Asterios Karagiannis
- 2 Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinic) and Department of Surgery, Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom
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Hobbs FDR, Erhardt LR, Rycroft C. The From The Heart study: a global survey of patient understanding of cholesterol management and cardiovascular risk, and physician-patient communication. Curr Med Res Opin 2008; 24:1267-78. [PMID: 18355420 DOI: 10.1185/030079908x280491] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Cardiovascular disease (CVD) is the leading cause of mortality worldwide. A high level of low-density lipoprotein cholesterol (LDL-C) is a major CVD risk factor. Guidelines recommend effective cholesterol management and set LDL-C goals, yet deficiencies exist in physician implementation of these recommendations and in patient uptake of the advice. However, little is known of patient perceptions about CVD risk. METHODS Patients and physicians were randomly selected from ten countries to complete a confidential, semi-structured questionnaire. RESULTS Response rates were 27% (n = 750) for physicians and 83% (n = 1547) for patients. Patients believed cancer (43%) to be a greater cause of mortality than heart attack or stroke (34%). Despite 77% of patients claiming to be satisfied with information on high cholesterol, only 26% were aware that heart attack was a possible consequence, and only 35% of patients thought they had achieved their cholesterol goals. Virtually all physicians (99%) claimed to inform patients of their cholesterol level, while 18% of patients reported that they were not informed. Although patients and physicians were selected at random, limitations of this survey relate typically to the reliability of physician and patient responses and the possibility that the survey population may not represent the overall population. A broad range of patients' backgrounds and a high response rate (83%) suggest these effects would be minimal in the patient population. CONCLUSIONS The From The Heart study has shown surprisingly poor knowledge of CVD risk amongst patients with elevated cholesterol. This may contribute to poor concordance with recommendations and treatment.
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Affiliation(s)
- F D Richard Hobbs
- Primary Care Clinical Sciences Building, University of Birmingham, Birmingham, UK.
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Levine AP, Mikhailidis DP, Moross T, Benson K, Gor M. Achieving Vascular Risk Factor Targets: A Survey of a London General Practice. Angiology 2008; 59:36-46. [DOI: 10.1177/0003319707309538] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We assessed lipid goal achievement in patients at high risk for vascular events from a general practice (London, United Kingdom). Patients were identified as those with a prescription for hypolipidaemic medication, a significant (>20%) Framingham risk, and from the myocardial infarction register. Two hundred forty-five patients were currently taking a statin (average dose, 23.1 mg/day). Cholesterol, high-density lipoprotein—cholesterol, low-density lipoprotein—cholesterol, and triglycerides changed significantly following statin treatment. Of 285 patients who had taken statins at some time point, 11 (3.9%) were intolerant, 5 of which subsequently tolerated another statin. Approximately 10.1% of patients discontinued statin treatment for unclear reasons. Only 64 patients (29.1% of 220) reached the Joint British Societies' Guidelines on Prevention of Cardiovascular Disease target of a total cholesterol of <4.0 mmol/L; 50 patients (38.8% of 129) reached the low-density lipoprotein—cholesterol target of <2.0 mmol/L. This value of low-density lipoprotein—cholesterol is similar to that recommended by the American Heart Association/American College of Cardiology. With regard to the General Medical Services guidelines target for total cholesterol, 162 (73.6% of 220) patients reached ≤5.0 mmol/L. The group that best achieved target cholesterol (Joint British Societies' Guidelines and General Medical Services) were those with comorbidities. In conclusion, while reaching General Medical Services targets was satisfactory, the percentage of patients reaching Joint British Societies' Guidelines targets was not. This discrepancy may reflect the presence of multiple guidelines. The current stricter lipid targets are difficult to achieve; possible methods that may be used to improve lipids further could involve using combination therapy, statin dose titration, and better education.
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Affiliation(s)
- Adam P. Levine
- Crouch Hall Road Surgery, Hornsey, United Kingdom, Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital, Royal Free, University College School of Medicine, University College London (University of London), London, United Kingdom
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital, Royal Free, University College School of Medicine, University College London (University of London), London, United Kingdom,
| | - Tessa Moross
- Crouch Hall Road Surgery, Hornsey, United Kingdom
| | - Karen Benson
- Crouch Hall Road Surgery, Hornsey, United Kingdom
| | - Mayur Gor
- Crouch Hall Road Surgery, Hornsey, United Kingdom
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Leiter LA, Rosenson RS, Stein E, Reckless JPD, Schulte KL, Schleman M, Miller P, Palmer M, Sosef F. Efficacy and safety of rosuvastatin 40mg versus atorvastatin 80 mg in high-risk patients with hypercholesterolemia: Results of the POLARIS study. Atherosclerosis 2007; 194:e154-64. [PMID: 17229426 DOI: 10.1016/j.atherosclerosis.2006.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Revised: 12/01/2006] [Accepted: 12/01/2006] [Indexed: 10/23/2022]
Abstract
POLARIS investigated the efficacy and safety of rosuvastatin 40 mg and atorvastatin 80 mg in high-risk patients with hypercholesterolemia. Patients (n=871) were randomized to rosuvastatin 40 mg/day or atorvastatin 80 mg/day for 26 weeks. The primary endpoint was percentage change in LDL-C levels at 8 weeks. Secondary assessments included safety and tolerability, NCEP ATP III LDL-C goal achievement, change in other lipids and lipoproteins at 8 and 26 weeks, and health economics. Mean LDL-C levels were reduced significantly more with rosuvastatin 40 mg than with atorvastatin 80 mg at 8 weeks (-56% versus -52%, p<0.001). The proportion of patients achieving the NCEP ATP III LDL-C goal at 8 weeks was significantly higher in the rosuvastatin 40 mg group (80% versus 72%, p<0.01). Significant differences in the change from baseline in high-density lipoprotein cholesterol (HDL-C) (+9.6% versus +4.4%) and apolipoprotein (Apo)A-I levels (+4.2 versus -0.5) were observed between rosuvastatin and atorvastatin (all p<0.05). Both treatments were well tolerated. Based on a US analysis, rosuvastatin used fewer resources and delivered greater efficacy. Intensive lipid-lowering therapy with rosuvastatin 40 mg/day provided greater LDL-C-lowering efficacy than atorvastatin 80 mg/day, enabling more patients to achieve LDL-C goals. Rosuvastatin may therefore improve LDL-C goal achievement in high-risk patients with hypercholesterolemia.
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Affiliation(s)
- Lawrence A Leiter
- Division of Endocrinology and Metabolism, St. Michael's Hospital, University of Toronto, Toronto, Canada.
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Rodríguez-Roca GC, Alonso-Moreno FJ, Barrios V, Llisterri JL, Lou S, Matalí A, Banegas JR. Características de la presión arterial en una población dislipémica española asistida en atención primaria. Estudio LIPICAP-PA. Rev Esp Cardiol 2007. [DOI: 10.1157/13108996] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Erhardt LR, Hobbs FDR. A global survey of physicians' perceptions on cholesterol management: the From The Heart study. Int J Clin Pract 2007; 61:1078-85. [PMID: 17577295 DOI: 10.1111/j.1742-1241.2007.01420.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS Guidelines for cardiovascular disease (CVD) prevention cite high levels of low-density lipoprotein cholesterol (LDL-C) as a major risk factor and recommend LDL-C goals for various risk groups. Lifestyle changes are advised as first-line treatment for patients with high cholesterol, and statins are recommended in high-risk patients. The From The Heart study investigated current practice for the diagnosis and treatment of high cholesterol, and attitudes towards management of the condition. METHODS Physicians were randomly selected from 10 countries, and completed a confidential, semi-structured questionnaire. RESULTS Of 2790 physicians agreeing to participate, 750 (27%) responded. Physicians rated CVD as the leading cause of death, although physicians (80%) perceived that cancer was the most feared illness among patients. Physicians (71%) believed smoking to be the greatest CVD risk factor, while only 50% thought high cholesterol was the greatest risk. Most physicians (81%) used guidelines to set cholesterol goals, primarily their national guidelines (34%) or the National Cholesterol Education Program Adult Treatment Panel III guidelines (24%). Although only 47% of patients reached and maintained their cholesterol goals, 61% of physicians believed that a sufficient number of patients achieved goals, and 53% did not feel frustrated that they could not always effectively treat patients with CVD. CONCLUSION Results indicate discrepancies between guideline recommendations and clinical practice. Although physicians appreciate the risk of CVD, the importance of achieving healthy cholesterol levels for CVD prevention does not seem to be widely endorsed. There is a need for improved communication regarding the importance of cholesterol lowering and investigation of initiatives to improve goal achievement among physicians.
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Affiliation(s)
- L R Erhardt
- Department of Cardiology, Lund University, Malmö University Hospital, Malmö, Sweden
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Deambrosis P, Saramin C, Terrazzani G, Scaldaferri L, Debetto P, Giusti P, Chinellato A. Evaluation of the prescription and utilization patterns of statins in an Italian local health unit during the period 1994-2003. Eur J Clin Pharmacol 2007; 63:197-203. [PMID: 17200832 DOI: 10.1007/s00228-006-0239-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 11/17/2006] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The prescription pattern of statins in the Local Health Unit (LHU) of Treviso (northern Italy) over a 10-year period was evaluated, with the aim of evaluating the persistence with and adherence to therapy. METHODS Data on 21,393 subjects who received at least one prescription for statins during the period between January 1, 1994 and December 31, 2003 were retrieved from the LHU database in order to track the pharmacological history of individual patients. The data included age, sex, drug formulation, strength, number of drug packages prescribed, and prescription date. The adopted indicators for drug utilization included the Defined Daily Dose (DDD), the Received Daily Dose (RDD), and a surrogated Prescribed Daily Dose (sPDD), extrapolated from available prescription data. An Adherence to Therapy Index (ATI) was calculated from the ratio between the amount of drug actually prescribed and the amount of sPDD. Based on the ATI, patients were grouped into non-adherent, poor-adherent, and good-adherent groups. The distribution of adherence level among patient-age classes and statin-prescribed patients in primary or secondary prevention was evaluated. RESULTS All drug-utilization indicators showed an increase in statin use over the study period in terms of both the number of prescribed patients and the sPDD. Persistence with and adherence to therapy remained low, with a 50% discontinuation rate in the first year, and persistent patients did not follow the therapy regularly. Patients in secondary prevention were the most adherent to their drug regimen, although only 41% of these had a good compliance. CONCLUSIONS Our findings suggest an increase in statin use which is, however, accompanied by poor patient persistence with and adherence to statin therapy.
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Affiliation(s)
- Paola Deambrosis
- Pharmaceutical Service, Local Health Authority (ULSS 9), Treviso, Italy
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Grado de control de la dislipemia en los pacientes españoles asistidos en atención primaria. Estudio LIPICAP. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2006. [DOI: 10.1016/s0214-9168(06)73694-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
BACKGROUND The dose range for rosuvastatin in Europe has recently been expanded to 5 to 40 mg and is now in line with the dose range currently available in the United States. OBJECTIVE The goal of this article was to review the efficacy and safety data available for the rosuvastatin 5-mg dose and discuss these data in the context of the full 5- to 40-mg dose range. METHODS Articles referring to clinical efficacy or safety data for the 5-mg dose of rosuvastatin were identified and reviewed after a search of the MEDLINE database (2000-August 2006; English language only) using the search term rosuvastatin. Proceedings from major cardiology congresses (2000-2006) were also searched for additional information. RESULTS Rosuvastatin 5 mg is significantly (P < 0.001) more effective at reducing low-density lipoprotein cholesterol (LDL-C) and total cholesterol (42% and 30%) levels compared with atorvastatin 10 mg (36% and 27%), simvastatin 20 mg (36% and 25%), and pravastatin 20 mg (27% and 19%). Rosuvastatin 5 mg allows significantly more patients to reach their LDL-C goals as recommended by the 2003 European guidelines and the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (49%-52% and 67%-71%) than atorvastatin 10 mg (36%, P < 0.001; 53%, P < 0.01), simvastatin 20 mg (37%, P < 0.001; 64%, P < 0.05), and pravastatin 20 mg (12%, P < 0.001; 49%, P < 0.001). Rosuvastatin is well tolerated across the 5- to 40-mg dose range, with a type and incidence of adverse events similar to the other commonly available, but less effective, statins. The introduction of a 5-mg dose offers greater flexibility to prescribing physicians in that it provides an additional dosing option for those patients who are at a lower cardiovascular risk or who have an increased potential for developing myopathy with statin therapy. CONCLUSIONS Rosuvastatin 5 mg is well tolerated and has beneficial effects across the atherogenic lipid profile by reducing LDL-C and total cholesterol, raising high-density lipoprotein cholesterol, and helping a greater proportion of patients reach their LDL-C goals.
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Affiliation(s)
- Anders G Olsson
- Department of Medicine and Care, University Hospital, Linköping, Sweden.
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14
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Banegas JR, Vegazo O, Serrano P, Luengo E, Mantilla T, Fernández R, Civeira F. The gap between dyslipidemia control perceived by physicians and objective control patterns in Spain. Atherosclerosis 2006; 188:420-4. [PMID: 16343505 DOI: 10.1016/j.atherosclerosis.2005.11.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Revised: 10/24/2005] [Accepted: 11/07/2005] [Indexed: 02/07/2023]
Abstract
OBJECTIVE It is well-known that adequate control of dyslipidemia is low. But little is known about how well physicians perceive the control of their dyslipidemic patients. This study examines physicians' subjective perception of dyslipidemia control, and compares it with control determined objectively with published guidelines. METHODS A total of 33,913 patients were studied cross-sectionally in 164 Spanish outpatients' clinics. Of these patients, 5583 were evaluable patients with a documented diagnosis of dyslipidemia. Control of dyslipidemia was evaluated by two methods: the physician's opinion on their patient's lipid levels (adequate control or inadequate control), and the proportion of patients who objectively reach the LDL-cholesterol goals of the National Cholesterol Education Program (NCEP/ATPIII). RESULTS Physicians perceived that 44% (95% CI 42.7-45.3%) of their patients had an adequate control of their dyslipidemia, but only 32.8% (95% CI 31.6-34.0%) were objectively controlled. Subjective control hardly changed across the NCEP cardiovascular risk groups, but objective control was lower in the 2372 coronary heart disease patients (15.1%) and in the 1407 moderately high-risk patients (29.6%) than in the 1804 lower risk patients (58.5%). Physicians' perception of control was significantly and independently associated with objective control (P<0.001). CONCLUSIONS Physicians overestimate dyslipidemia control in the majority of their patients. Misperception of control by physicians may contribute to the low achievement of objective control.
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Affiliation(s)
- José R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid, Avda. Arzobispo Morcillo s/n, 28029 Madrid, Spain.
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Walley T, Folino-Gallo P, Stephens P, Van Ganse E. Trends in prescribing and utilization of statins and other lipid lowering drugs across Europe 1997-2003. Br J Clin Pharmacol 2006; 60:543-51. [PMID: 16236045 PMCID: PMC1884951 DOI: 10.1111/j.1365-2125.2005.02478.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIMS To describe trends in utilization and prescribing of statins and other lipid lowering drugs across Europe from data in routine administrative databases. METHODS Observational study in EU member states and Norway. Comparison of annual utilization data for lipid lowering agents by class and drug from national administrative databases for reimbursement over the period 1997-2003, measured in DDDs per 1000 inhabitants/day. Prescribed daily doses (PDD) of statins obtained from a commercial database (IMS Health) for 2000 and 2003, and used to calculate numbers of "patient treatment days" (PTD) in each country in each year. Analysis of PTD to explain increased utilization of statins. RESULTS Use of lipid lowering agents varied among countries (in 2003, highest in Ireland and Norway, and lowest in Italy), but increased in all countries studied (between 2000 and 2003 by 274% in Ireland and by 56% in France). This increase was entirely due to increases in statin use. Prescribed daily doses of statins increased in all countries for which data was available between 2000 and 2003, but still usually fell below the doses used in the major trials of statins. As a result, the numbers of PTDs increased to a lesser extent than suggested by utilization (e.g. by 192% in Ireland and by 35% in France). One-third of the total rise in utilization was explained by increased PDD, and two-thirds by an increase in numbers of PTDs. Statins dominated the markets in all countries, although fibrates remained strong in France and Belgium (approximately 25% of all lipid lowering agents) and to a lesser extent Germany (10%). CONCLUSIONS Use of statins across Europe has increased hugely over the study period. Some of the increase in use is due to higher prescribed daily doses, but two-thirds is due to increases in numbers of patient days of treatment, either due to more patients treated or less likely to better compliance.
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Affiliation(s)
- T Walley
- Department of Pharmacology and Therapeutics, University of Liverpool, 70 Pembrooke Place, Liverpool L69 3GF, UK.
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Binbrek AS, Elis A, Al-Zaibag M, Eha J, Keber I, Cuevas AM, Mukherjee S, Miller TR. Rosuvastatin versus atorvastatin in achieving lipid goals in patients at high risk for cardiovascular disease in clinical practice: A randomized, open-label, parallel-group, multicenter study (DISCOVERY Alpha study). CURRENT THERAPEUTIC RESEARCH 2006; 67:21-43. [PMID: 24936119 PMCID: PMC4052636 DOI: 10.1016/j.curtheres.2006.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2005] [Indexed: 12/12/2022]
Abstract
BACKGROUND The majority of clinical trials investigating the clinical benefits of lipid-lowering therapies (LLTs) have focused on North American or western and nothern European populations. Therefore, it is timely to confirm the efficacy of these agents in other patient populations in routine clinical practice. OBJECTIVE The aim of the Direct Statin COmparison of low-density lipoprotein cholesterol (LDL-C) Values: an Evaluation of Rosuvastatin therapY (DISCOVERY) Alpha study was to compare the effects of rosuvastatin 10 mg with those of atorvastatin 10 mg in achieving LDL-C goals in the Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice guidelines. METHODS This randomized, open-label, parallel-group study was conducted at 93 centers in eastern Europe (Estonia, Latvia, Romania, Russia, Slovenia), Central and South America (Chile, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Panama), and the Middle East (Israel, Kuwait, Saudi Arabia, United Arab Emirates). Male and female patients aged ≥18 years with primary hypercholesterolemia (LDL-C level, >135 mg/dL if LLT-naive or ≥120 mg/dL if switching statins; triglyceride [TG] level, <400 mg/dL) and a 10-year coronary heart disease (CHD) risk >20% or a history of CHD or other established atherosclerotic disease were eligible for inclusion in the study. Patients were randomly assigned to receive rosuvastatin 10-mg or atorvastatin 10-mg tablets QD for 12 weeks. No formal statistical analyses or comparisons were performed on lipid changes between switched and LLT-naive patients because of the different lipid inclusion criteria for these patients. The primary end point was the proportion of patients achieving 1998 European LDL-C goals after 12 weeks of treatment. A subanalysis was performed to assess the effects of statins in patients who had received previous statin treatment versus those who were LLT-naive. Tolerability was assessed using laboratory analysis and direct questioning of the patients. RESULTS A total of 1506 patients (52.1% women, 47.9% men; mean [SD] age, 58.2 [10.8] years) participated in the study (rosuvastatin, 1002 patients; atorvastatin, 504 patients; previous LLT, 567 patients). A significantly higher proportion of patients achieved 1998 European LDL-C goals after 12 weeks with rosuvastatin 10 mg than with atorvastatin 10 mg (72.5% vs 56.6%; P < 0.001). Similarly, more patients achieved the 2003 European LDL-C goals with rosuvastatin 10 mg compared with atorvastatin 10 mg (57.5% vs 39.2%). Rosuvastatin 10 mg was associated with a significantly greater change in LDL-C levels compared with atorvastatin 10 mg, in patients who were LLT-naive (LDL-C: -44.7% vs -33.9%; P < 0.001) and in patients who had received previous LLT (LDL-C: -32.0% vs -26.5%; P = 0.006). TG levels were also decreased with rosuvastatin 10 mg and atorvastatin 10 mg, although there was no significant difference between treatments. Similarly, there was no significant difference in the increase in high-density lipoprotein cholesterol levels between treatments. The most common adverse events overall were headache 16/1497 (1.1%), myalgia 10/1497 (0.7%), and nausea 10/1497 (0.7%). CONCLUSIONS In this study in patients with primary hypercholesterolemia in clinical practice, greater reductions in LDL-C levels were achieved with a starting dose (10 mg) of rosuvastatin compared with atorvastatin 10 mg, with more patients achieving European LDL-C goals. Both treatments were well tolerated.
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Affiliation(s)
- Azan S. Binbrek
- Department of Cardiology, Rashid Hospital, Dubai, United Arab Emirates
| | - Avishay Elis
- Meir Hospital, Kfar-Saba, Tel Aviv, Israel
- Sockler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Irena Keber
- University Klinični Center Ljubljana, Ljubljana, Slovenia
| | - Ada M. Cuevas
- Nutrition Center, Clinica Las Condes, Santiago, Chile
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