1
|
Kvitkina T, Narres M, Claessen H, Metzendorf MI, Richter B, Icks A. Incidence of Stroke in People With Diabetes Compared to Those Without Diabetes: A Systematic Review. Exp Clin Endocrinol Diabetes 2023; 131:476-490. [PMID: 37279879 PMCID: PMC10506631 DOI: 10.1055/a-2106-4732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/24/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND One of the goals of the St. Vincent Declaration was to reduce serious complications of diabetes, including strokes. However, it remains uncertain whether this goal has been achieved. STUDY AIM To evaluate the incidence of stroke in the diabetic population and its differences regarding sex, ethnicity, age, and region, to compare the incidence rate in people with and without diabetes, and to investigate time trends. MATERIALS AND METHODS A systematic review was conducted according to the guidelines for meta-analysis of observational studies in epidemiology (the MOOSE group) and the PRISMA group guidelines. RESULTS Nineteen of the 6.470 studies retrieved were included in the analysis. The incidence of stroke in the population with diabetes ranged from 238 per 100,000 person-years in Germany in 2014 to 1191 during the 1990s in the United Kingdom. The relative risk comparing people with diabetes to those without diabetes varied between 1.0 and 2.84 for total stroke, 1.0 and 3.7 for ischemic stroke, and 0.68 and 1.6 for hemorrhagic stroke. Differences between fatal and non-fatal stroke were significant, depending on the time period and the population. We found decreasing time trends in people with diabetes and stable incidence rates of stroke over time in people without diabetes. CONCLUSION The considerable differences between results can partly be explained by differences in study designs, statistical methods, definitions of stroke, and methods used to identify patients with diabetes. The lack of evidence arising from these differences ought to be rectified by new studies.
Collapse
Affiliation(s)
- Tatjana Kvitkina
- Institute for Health Services Research and Health Economics, German
Diabetes Center, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for
Health and Society, Medical Faculty of the Heinrich-Heine University
Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg,
Germany
| | - Maria Narres
- Institute for Health Services Research and Health Economics, German
Diabetes Center, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for
Health and Society, Medical Faculty of the Heinrich-Heine University
Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg,
Germany
| | - Heiner Claessen
- Institute for Health Services Research and Health Economics, German
Diabetes Center, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for
Health and Society, Medical Faculty of the Heinrich-Heine University
Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg,
Germany
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General
Practice, Medical Faculty of the Heinrich-Heine University Düsseldorf,
Germany
| | - Bernd Richter
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General
Practice, Medical Faculty of the Heinrich-Heine University Düsseldorf,
Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German
Diabetes Center, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Centre for
Health and Society, Medical Faculty of the Heinrich-Heine University
Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Neuherberg,
Germany
| |
Collapse
|
2
|
Jancsó Z, Csenteri O, Szőllősi GJ, Vajer P, Andréka P. Cardiovascular risk management: the success of target level achievement in high- and very high-risk patients in Hungary. BMC PRIMARY CARE 2022; 23:305. [PMID: 36447162 PMCID: PMC9706967 DOI: 10.1186/s12875-022-01922-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The management of risk factors in patients with high cardiovascular risk and its effectiveness is of paramount importance. Over the last decade, several studies have examined the achievement of cardiovascular risk factors' target levels in Europe. In the present Hungarian study, we assessed the cardiovascular risk level of participants aged 40-65 years and the success of achieving risk factors' target levels in high- and very high-risk patients. We compared these results with the results of two similar European studies. METHODS We conducted a cross-sectional study involving 37,778 patients aged 40-65 years from Hungary between 2019 and 2020. Cardiovascular risk levels and target values were set according to the 2016 European Guideline. Target achievement was evaluated for body mass index, waist circumference, blood pressure, total, LDL, and HDL cholesterol, triglyceride, and HbA1c (in diabetics). RESULTS For 37,298 patients, all the data were available to determine their cardiovascular risk category. Of these, 23.1% had high and 31.4% had very high cardiovascular risk (men: 27.1 and 39.6%, women: 20.5 and 26.1%, respectively). Achievement of the LDL-C target of 1.8 mmol/l was only 8.0% among very high-risk patients, which was significantly lower than the European average (29%). Achievement of target blood pressure among high-risk patients was better than the European average (63.4% vs. 44.7%, respectively); however, achievement was slightly lower among very high-risk patients compared with the European average (49.4% vs. 58%, respectively). The proportion of patients with type 2 diabetes who achieved a HbA1c below 7% was 57.3% in the high-risk population and 53% in the very high-risk population, which was in line with the European average success rates (58.5 and 54%, respectively). Waist circumference (< 88 cm for women and < 102 cm for men) was achieved by 29.4% of patients in the very high-risk group in our survey, which was lower than the European average of 41%. CONCLUSIONS The success rate of cardiovascular risk management in Hungary is lower than the European average in several parameters. Furthermore, our data highlight the poor effectiveness of obesity management in Hungary. General practice partnerships may be important sites for positive change.
Collapse
Affiliation(s)
- Zoltán Jancsó
- Gottsegen National Cardiovascular Center, Haller u. 29, Budapest, 1096 Hungary
| | - Orsolya Csenteri
- Gottsegen National Cardiovascular Center, Haller u. 29, Budapest, 1096 Hungary
| | | | - Péter Vajer
- Gottsegen National Cardiovascular Center, Haller u. 29, Budapest, 1096 Hungary
| | - Péter Andréka
- Gottsegen National Cardiovascular Center, Haller u. 29, Budapest, 1096 Hungary
| |
Collapse
|
3
|
Csenteri O, Jancsó Z, Szöllösi GJ, Andréka P, Vajer P. Differences of cardiovascular risk assessment in clinical practice using SCORE and SCORE2. Open Heart 2022; 9:openhrt-2022-002087. [PMID: 36442905 PMCID: PMC9710472 DOI: 10.1136/openhrt-2022-002087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Cardiovascular risk estimation is an essential step to reduce the onset of adverse cardiovascular events. For this purpose, the Systematic Coronary Risk Evaluation (SCORE) risk chart method was used in Europe. In 2021, the SCORE2 algorithm was released, bringing changes in the calculation methodology. This study assessed and compared the level of cardiovascular risk in a population aged 40-65 years using the SCORE and SCORE2 methodologies. METHODS This cross-sectional study included a total of 85 802 patients in Hungary. Cardiovascular risk levels were determined using the SCORE and SCORE2 risk estimation methods. RESULTS Using SCORE, 97.7% of men aged 40-50 years were classified as low-moderate risk, which decreased to 32.4% using SCORE2. Using SCORE, 100% of women aged 40-50 years were classified as low-moderate risk, compared with 75.6% using SCORE2. Using SCORE, 36.8% of men aged 50-65 years were classified as high risk and 14.8% as very high risk, and 5.4% of women aged 50-65 years were classified as high risk and 0.5% as very high risk. In this age group, using SCORE2, 50% of men were classified as high risk and 25.8% as very high risk, and 38.8% of women were classified as high risk and 11.9% as very high risk. CONCLUSIONS When the SCORE2 method was used instead of SCORE 43.91% of the whole population were classified with a higher level of risk, which represents a radical increase in the number of patients with high or very high cardiovascular risk.
Collapse
Affiliation(s)
- Orsolya Csenteri
- Gottsegen György Országos Kardiológiai Intézet, Budapest, Hungary
| | - Zoltán Jancsó
- Gottsegen György Országos Kardiológiai Intézet, Budapest, Hungary
| | | | - Péter Andréka
- Gottsegen György Országos Kardiológiai Intézet, Budapest, Hungary
| | - Péter Vajer
- Gottsegen György Országos Kardiológiai Intézet, Budapest, Hungary,Family Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
| |
Collapse
|
4
|
Kiss Z, Rokszin G, Abonyi-Tóth Z, Jermendy G, Kempler P, Aradi D, Wittmann I. Dissimilar impact of type 2 diabetes on cardiovascular outcomes according to age categories: a nationwide population study from Hungary. Cardiovasc Diabetol 2018; 17:107. [PMID: 30053870 PMCID: PMC6062985 DOI: 10.1186/s12933-018-0751-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/23/2018] [Indexed: 12/21/2022] Open
Abstract
Background The excess risks of mortality and cardiovascular morbidity among patients with type 2 diabetes mellitus (T2DM) is well known. In this nationwide study, we assessed risks of mortality and cardiovascular events comparing patients with T2DM and matched controls. Methods We identified patients with T2DM in a retrospective cohort study using the database of the National Health Insurance Fund between 1 January 2010 and 31 December, 2013. Controls were randomly included and matched according to age, gender, and zip code of residence. Patients were divided into subgroups according to age decades for outcome analyses. Results During the mean follow-up period of 2.3 years, 152,678 patients with T2DM and 305,356 matched controls were included. Patients with T2DM showed significantly higher risk for all-cause mortality (HR 1.26, 95% CI 1.22–1.29, p < 0.0001), myocardial infarction (HR 1.81, 95% CI 1.69–1.94, p < 0.0001) and stroke (HR 1.40, 95% CI 1.35–1.46, p < 0.0001) compared to matched controls. The higher risk associated with T2DM for mortality, myocardial infarction and stroke differed significantly between age groups (pinteraction < 0.05 for all outcomes) with significantly higher risk observed in younger patients. Conclusions The risk of cardiovascular outcomes and all-cause mortality is significantly higher in patients with T2DM. Notably, the relative hazard increases with decreasing age suggesting that younger patients with T2DM should receive more attention for cardiovascular prevention.
Collapse
Affiliation(s)
- Zoltán Kiss
- 2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pacsirta str. 1, Pecs, 7624, Hungary
| | | | - Zsolt Abonyi-Tóth
- RxTarget Ltd., Szolnok, Hungary.,University of Veterinary Medicine, Budapest, Hungary
| | | | - Péter Kempler
- I. Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Dániel Aradi
- Heart Centre Balatonfüred and Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - István Wittmann
- 2nd Department of Medicine and Nephrological Center, Faculty of Medicine, University of Pécs, Pacsirta str. 1, Pecs, 7624, Hungary.
| |
Collapse
|
5
|
Trivedi LU, Alvarez CA, Mansi IA. Association of Statin Therapy With Risk of Epilepsy in 2 Propensity Score-Matched Cohorts. Ann Pharmacother 2018; 52:546-553. [PMID: 29400081 DOI: 10.1177/1060028018756650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Studies have suggested that statins may have a neuroprotective effect against epilepsy. However, evidence from rat models and case reports have suggested an opposite effect. Overall data are limited. OBJECTIVE To examine the association between statin use and epilepsy risk in a general population and in a healthy population (individuals with no severe comorbidities). METHODS Patients were Tricare beneficiaries from October 2003 to March 2012. Based on patients' characteristics during baseline phase (fiscal year [FY] 2004-2005), 2 propensity score (PS)-matched cohorts of statin users and nonusers were formed: (1) a PS-matched general cohort and (2) a PS-matched healthy cohort. Our outcome was defined using inpatient or outpatient ICD-9 codes for epilepsy during the follow-up phase (FY 2006 to March 2012) in the cohorts of statin users and nonusers. RESULTS The study included a total of 43 438 patients (13 626 statin users and 29 812 nonusers). The PS-matched general cohort matched 6342 statin users to 6342 nonusers; the odds ratio (OR) of epilepsy in this cohort during follow-up was 0.91; 95% CI = 0.67-1.23. The PS-matched healthy cohort matched 3351 statin users to 3351 nonusers; OR in the PS-matched healthy cohort during follow-up was 1.08; 95% CI = 0.64-1.83. CONCLUSIONS This study did not demonstrate a significant beneficial or deleterious effect of statin use on risk of being diagnosed with epilepsy. Clinicians should not withhold statins, whenever indicated, in patients with epilepsy.
Collapse
Affiliation(s)
| | | | - Ishak A Mansi
- 1 University of Texas Southwestern Medical Center, Dallas, TX, USA.,3 VA North Texas Health Care System, Dallas, TX, USA
| |
Collapse
|
6
|
Mansi IA, English J, Zhang S, Mortensen EM, Halm EA. Long-Term Outcomes of Short-Term Statin Use in Healthy Adults: A Retrospective Cohort Study. Drug Saf 2016; 39:543-59. [DOI: 10.1007/s40264-016-0412-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
7
|
Banach M, Aronow WS, Serban MC, Rysz J, Voroneanu L, Covic A. Lipids, blood pressure and kidney update 2015. Lipids Health Dis 2015; 14:167. [PMID: 26718096 PMCID: PMC4696333 DOI: 10.1186/s12944-015-0169-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 12/22/2015] [Indexed: 02/07/2023] Open
Abstract
The most important studies and guidelines in the topics of lipid, blood pressure and kidney published in 2015 were reviewed. In lipid research, the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial revalidated the concept "lower is better" for low density lipoprotein (LDL)-cholesterol as a target for therapy, increasing the necessity of treatment the high-risk patients to achieve LDL-C goals. After these results, ezetimibe might become the preferred additional drug in the combination therapy of lipid disorders because of oral dosage form and lower acquisition cost. However, for the statin-intolerant patients and those patients requiring essential reductions in LDL-C to achieve their goals, new therapies, including PCSK9 inhibitors remain promising drugs. In blood pressure research, American Heart Association (AHA)/American College of Cardiology (ACC) 2015 guidelines recommended a target for blood pressure below 140/90 mmHg in stable or unstable coronary artery disease patients and below 150/90 mmHg in patients older than 80 years of age, however the recent results of the Systolic Blood Pressure Intervention Trial (SPRINT) trial have suggested that there might be significant benefits, taking into account cardiovascular risk, for hypertensive patients over 50 without diabetes and blood pressure levels <120/80. In kidney research, reducing the progression of chronic kidney disease and related complications such as anemia, metabolic acidosis, bone and mineral diseases, acute kidney injury and cardiovascular disease is still a goal for clinicians.
Collapse
Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland.
| | - Wilbert S Aronow
- Department of Medicine, New York Medical College, Valhalla, NY, USA
| | - Maria-Corina Serban
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Jacek Rysz
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland
| | - Luminita Voroneanu
- Nephrology Clinic, Dialysis and Renal Transplant Center, C.I. Parhon University Hospital and Grigore. T. Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, C.I. Parhon University Hospital and Grigore. T. Popa, University of Medicine and Pharmacy, Iasi, Romania
| |
Collapse
|
8
|
Serban MC, Banach M, Mikhailidis DP. Clinical implications of the IMPROVE-IT trial in the light of current and future lipid-lowering treatment options. Expert Opin Pharmacother 2015; 17:369-80. [PMID: 26559810 DOI: 10.1517/14656566.2016.1118055] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION A residual risk of morbidity and mortality from cardiovascular (CV) disease remains despite statin therapy. This situation has generated an interest in finding novel approaches of combining statins with other lipid-lowering agents, or finding new lipid and non-lipid targets, such as triglycerides, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, proprotein convertase subtilisin/kexin type 9 (PCSK9) gene, cholesterol ester transfer protein (CETP), lipoprotein (a), fibrinogen or C-reactive protein. AREAS COVERED The recent results from the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) demonstrated an incremental clinical benefit when ezetimibe, a non-statin agent, was added to simvastatin therapy. EXPERT OPINION The results from IMPROVE-IT revalidated the concept that low-density lipoprotein cholesterol (LDL-C) levels are a clinically relevant treatment goal. This trial also suggested that further decrease of LDL-C levels (53 vs. 70 mg/dl; 1.4 vs. 1.8 mmol/l) was more beneficial in lowering CV events. This "even lower is even better" evidence for LDL-C levels may influence future guidelines and the use of new drugs. Furthermore, these findings make ezetimibe a more realistic option to treat patients with statin intolerance or those who cannot achieve LDL-C targets with statin monotherapy.
Collapse
Affiliation(s)
- Maria-Corina Serban
- a Department of Epidemiology , University of Alabama at Birmingham , Birmingham , USA.,b Department of Functional Sciences, Discipline of Pathophysiology , "Victor Babes" University of Medicine and Pharmacy , Timisoara , Romania
| | - Maciej Banach
- c Department of Hypertension, Chair of Nephrology and Hypertension , Medical University of Lodz , Lodz , Poland
| | - Dimitri P Mikhailidis
- d Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School , University College London (UCL) , London , UK
| |
Collapse
|
9
|
Khalil D, Boktor M, Mortensen EM, Frei CR, Mansi I. Comparison of frequency of inflammatory bowel disease and noninfectious gastroenteritis among statin users versus nonusers. Am J Cardiol 2015; 115:1396-401. [PMID: 25784517 DOI: 10.1016/j.amjcard.2015.02.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/06/2015] [Accepted: 02/06/2015] [Indexed: 12/18/2022]
Abstract
Conflicting data exist regarding the effects of statin therapy on the prevalence of inflammatory bowel diseases. We aimed to examine the association of statin therapy with diagnoses of inflammatory bowel diseases and noninfectious gastroenteritis. This is a retrospective study using data of a military health care system from October 1, 2003, to March 1, 2012. Based on medication fills during fiscal year 2005, patients were divided into: (1) statin users (received at least 90-day supply of statin) and (2) nonusers (never received a statin). A propensity score-matched cohort of statin users and nonusers was created using 80 variables. Primary analysis examined the risks of being diagnosed with inflammatory bowel diseases and noninfectious gastroenteritis between statin users and nonusers in the propensity score-matched cohort. Secondary analyses examined the risk of outcomes in the whole cohort and in patients with no comorbidities according to Charlson Comorbidity Index. Of 43,438 patients meeting study criteria (13,626 statin users and 29,812 nonusers), we propensity score matched 6,342 statin users with 6,342 nonusers. For our primary analysis, 93 statin users and 92 nonusers were diagnosed with inflammatory bowel diseases (odds ratio = 1.01, 95% confidence interval = 0.76 to 1.35), and 632 statin users and 619 nonusers were diagnosed of noninfectious gastroenteritis (odds ratio = 1.02, 95% confidence interval = 0.91 to 1.15). In conclusion, the risks of inflammatory bowel diseases and noninfectious gastroenteritis among statin users and nonusers are similar after adjusting for other potential confounding factors.
Collapse
|
10
|
Petyaev IM. Improvement of hepatic bioavailability as a new step for the future of statin. Arch Med Sci 2015; 11:406-10. [PMID: 25995759 PMCID: PMC4424257 DOI: 10.5114/aoms.2015.50972] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/30/2014] [Accepted: 04/27/2014] [Indexed: 02/04/2023] Open
Abstract
Statins (HMG-CoA reductase inhibitors) are a group of highly efficient pharmacological agents used for reducing blood cholesterol level and prevention/treatment of cardiovascular disease. Adverse reactions during statin treatment affect quite significant numbers of patients (reportedly from 5% to 20%), with more side effects occurring at higher doses. Reduced statin dosing can be achieved by improved bioavailability of statins, which is fairly low due to poor aqueous solubility, low permeability and high molecular weight of some members of the statin family. Moreover, since hepatic cholesterologenesis is a main target of statin action and extrahepatic inhibition of HMG-CoA reductase has no effect on plasma lipids, hepatic bioavailability, in our opinion, becomes a new important modality of statins maximizing their potential effect on the plasma lipid profile and diminishing their extrahepatic toxicity. Therefore efficient delivery systems of statins into hepatocytes need to be developed and introduced. Uses of nano-emulsifying statin delivery systems which may include vectors of intrahepatic transport, in particular lycopene, are discussed. As a proof of concept, some preliminary results revealing the effect of a lycopene-containing nanoformulation of simvastatin (designated as Lyco-Simvastatin) on LDL in mildly hypercholesterolemic patients are shown.
Collapse
Affiliation(s)
- Ivan M Petyaev
- Lycotec Ltd, Granta Park Campus, Cambridge, CB21 6GP, United Kingdom
| |
Collapse
|
11
|
Primary non-adherence in Portugal: findings and implications. Int J Clin Pharm 2015; 37:626-35. [PMID: 25832675 DOI: 10.1007/s11096-015-0108-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 03/20/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Portugal is currently facing a serious economic and financial crisis, which is dictating some important changes in the health care sector. Some of these measures may potentially influence patients' access to medication and consequently adherence, which will ultimately impact on health status, especially in chronic patients. AIMS This study aimed at providing a snapshot of adherence in patients with chronic conditions in Portugal between March and April 2012. SETTING Community pharmacy in Portugal. METHOD A cross-sectional pilot study was undertaken, where patients were recruited via community pharmacies to a questionnaire study evaluating the number of prescribed and purchased drugs and, when these figures were inconsistent, the reasons for this. MAIN OUTCOME MEASURES Primary and secondary adherence measures. Failing to purchase prescription items was categorized as primary nonadherence. Secondary nonadherence was attributed to purchasing prescription items, but not taking medicines as prescribed. RESULTS Data were collected from 375 patients. Primary nonadherence was identified in 22.8 % of patients. Regardless of the underlying condition, the most commonly reported reason for primary non-adherence was having spare medicines at home ("leftovers"), followed by financial problems. The latter appeared to be related to the class of medicines prescribed. Primary non-adherence was associated with low income (<475 <euro>/month; p = 0.026). Secondary non-adherence, assessed by the 7-MMAS was detected in over 50 % of all patients, where unintentional nonadherence was higher than intentional nonadherence across all disease conditions. CONCLUSION This study revealed that more than one fifth of chronic medication users report primary nonadherence (22.8 %) and more than 50 % report secondary nonadherence. Data indicates that the existence of spare medicines and financial constraints occurred were the two most frequent reasons cited for nonadherence (47, 6-64, 8 and 19-45.5 %, depending on the major underlying condition, respectively).
Collapse
|
12
|
Banach M, Aronow WS, Serban C, Sahabkar A, Rysz J, Voroneanu L, Covic A. Lipids, blood pressure and kidney update 2014. Pharmacol Res 2015; 95-96:111-25. [PMID: 25819754 DOI: 10.1016/j.phrs.2015.03.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/14/2015] [Accepted: 03/15/2015] [Indexed: 12/22/2022]
Abstract
This paper is an effort to review all the most important studies and guidelines in the topics of lipid, blood pressure and kidney published in 2014. Irrespective of advances, the options for improving simultaneous hypercholesterolemia and hypertension management (as well as its complication - chronic kidney disease) remain a problem. Recommending hypolidemic, hypotensive and kidney disease drugs to obtain therapy targets in cardiovascular, diabetic, elderly and kidney disease (=high risk) patients might strengthen risk factor control, improve compliance and the therapy efficacy, and in the consequence reduce the risk of cardiovascular events and mortality rate. That is why the authors have decided to summary and discuss the recent scientific achievements in the field of lipid, blood pressure and kidney.
Collapse
Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland.
| | - Wilbert S Aronow
- Department of Medicine, New York Medical College, Valhalla, NY, USA
| | - Corina Serban
- Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Amirhossein Sahabkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Metabolic Research Centre, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Jacek Rysz
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland
| | - Luminita Voroneanu
- Nephrology Clinic, Dialysis and Renal Transplant Center, C.I. Parhon University Hospital and Grigore. T. Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- Nephrology Clinic, Dialysis and Renal Transplant Center, C.I. Parhon University Hospital and Grigore. T. Popa, University of Medicine and Pharmacy, Iasi, Romania
| |
Collapse
|
13
|
Mark L, Dani G, Vendrey R, Ruzsa J, Katona A. Improvement in prehospital time in acute coronary syndrome between 1985 and 2013 in the south-eastern area of Hungary. Wien Klin Wochenschr 2015; 127:218-21. [PMID: 25794562 DOI: 10.1007/s00508-015-0717-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 11/11/2014] [Indexed: 12/28/2022]
Abstract
Acute coronary syndrome (ACS) is a life-threatening condition and the time-period from the onset of symptoms to the patients' arrival into the hospital has crucial importance. The authors investigated retrospectively the patients' decision time (time from the onset of the symptoms to seeking medical help) and the transport time to hospital arrival. In Hungary, it is unique of its kind that the present data can be compared to those obtained in the same area almost three decades ago.One-hundred forty-two patients (106 males and 36 females) were involved in the study, the mean age ± SD was 62.4 ± 11.3 years. The median decision time was 40 min; the median hospital arrival time was 2 h and 13 min. These were significantly shorter than in 1985-1986. These time parameters were influenced neither by gender, age, the number of inhabitants in the patients' city, the patients' education level, the occurrence of any former coronary event in the family and nor by the fact that the type of ACS was myocardial infarction with or without ST segment elevation.During the last two and half decades both the decision and the hospital arrival time decreased significantly (by 39 and 28 %, respectively) probably due to greater knowledge of general practitioners and the better organized ambulance service. Further improvement is needed; this can be expected by consistent education of the patients.
Collapse
Affiliation(s)
- Laszlo Mark
- 2nd Department of Internal Medicine-Cardiology, Pandy Kalman Bekes County Hospital, Semmelweis u. 1., P.O. Box 46, 5701, Gyula, Hungary,
| | | | | | | | | |
Collapse
|
14
|
Simonyi G, Ferenci T. [Low persistence of simvastatin and ezetimibe fixed combination in the lipid lowering therapy]. Orv Hetil 2015; 156:141-5. [PMID: 25597318 DOI: 10.1556/oh.2015.30085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The high cholesterol level is a well-known modifiable cardiovascular risk factor. Adequate patient adherence is important to decrease the cardiovascular risk. AIM The aim of the authors was to evaluate the persistence on one-year treatment with the free or fixed combination of simvastatin and ezetimibe and rosuvastatin. METHOD Information from the National Health Insurance Found prescriptions database on pharmacy-claims between October 1, 2012 and September 30, 2013 was analyzed. The authors identified patients who filled prescriptions for fixed or free combinations of simvastatin and ezetimibe and rosuvastatin prescribed for the first time. The subjects have not received antilipemic therapy with similar drugs during the year preceding the study. Using Kaplan-Meier technique, the authors constructed persistence curves with a 95% confidence interval for point estimates calculated on a log scale. Patients who were still persistent at the closing date of the study were considered censored. For the modelling of the curves, the authors used semi-parametric Cox's regression where antihypertensive therapy was the only (categorical) explanatory variable, and the patients taking the fixed combination of simvastatin and ezetimibe were regarded as the reference group. RESULTS 204,699 patients met the inclusion criteria. During the study period, antilipemic therapy with simvastatin and ezetimibe free combination 10,030 and 7,613 fixed combination of these agents and 187,056 patients with rosuvastatin was started by patients. One-year persistence rate in patients taking simvastatin and ezetimibe as a free combination was 10.97%, whereas it was 24.35% in those on the fixed combination and 30.47% in those on rosuvastatin monotherapy. The hazard ratio of discontinuation of simvastatin and ezetimibe free combination was 1.73 [95% confidence interval: 1.61-1.85], p<0.0001 compared to fixed combination and 0.80 [95% confidence interval: 0.78-0.82], p<0.0001 compared to rosuvastatin. Considering only the 360-day study period, the mean duration of persistence was 107 days in patients on the free, 164 days in those taking the free combination of simvastatin and ezetimibe and 185 days those taking rosuvastatin. CONCLUSIONS This study demonstrated that one-year persistence of free and fixed combination of simvastatin and ezetimibe was significantly lower compared to rosuvastatin.
Collapse
Affiliation(s)
- Gábor Simonyi
- Szent Imre Egyetemi Oktatókórház Anyagcsere Központ Budapest Tétényi út 12-16. 1115
| | - Tamás Ferenci
- Óbudai Egyetem, Neumann János Informatikai Kar Élettani Szabályozások Csoport Budapest
| |
Collapse
|
15
|
Lilly SM, Mortensen EM, Frei CR, Pugh MJ, Mansi IA. Comparison of the risk of psychological and cognitive disorders between persistent and nonpersistent statin users. Am J Cardiol 2014; 114:1035-9. [PMID: 25212545 DOI: 10.1016/j.amjcard.2014.07.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 12/28/2022]
Abstract
Despite their cardiovascular benefits, statin use has been associated with a wide array of actual or perceived psychological and cognitive adverse events. The objective of this study was to compare baseline characteristics and the risk of developing psychological and cognitive disorders between persistent and nonpersistent statin users. We performed a retrospective cohort study (October 1, 2003, to March 1, 2010) of 13,626 statin users in a regional US military health-care system. The persistence of statin use was defined by cumulative pharmacy fill data. Outcomes were the occurrence of psychological diseases during follow-up using prespecified groups based on International Classification of Diseases, Ninth Revision, codes: (1) schizophrenia and psychosis, (2) major depression and bipolar disorders, (3) all psychological diseases, and (4) dementia and cognitive disorders. Statin users who were nonpersistent at 2 years were younger, less likely to be men, and had fewer co-morbidities than persistent users. They were also more likely to be diagnosed with schizophrenia or psychosis (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.20 to 2.10) and cognitive disorders (OR 1.56, 95% CI 1.19 to 2.03) during follow-up compared with persistent users. There was not an association between nonpersistence at 2 years and the development of depression and bipolar disorders (OR 0.99, 95% CI 0.85 to 1.15) or combined psychological diseases (OR 0.97, 95% CI 0.86 to 1.09). Cumulative persistence with statin therapy as a continuous measure was associated with less risk of all outcomes. In conclusion, persistent statin users did not demonstrate an increase in the diagnosis of psychological disorders compared with nonpersistent users. Nonpersistent statin use was associated with a greater likelihood of being diagnosed with psychotic or cognitive disorders.
Collapse
Affiliation(s)
- Steven M Lilly
- Department of Internal Medicine, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Eric M Mortensen
- Department of Internal Medicine, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christopher R Frei
- College of Pharmacy, The University of Texas at Austin, Austin, Texas; Pharmacotherapy Education and Research Center, School of Medicine, University of Texas Health Science Center, San Antonio, Texas
| | - Mary Jo Pugh
- Department of Epidemiology and Biostatistics, Veterans Affairs South Texas Health Care System and University of Texas Health Science Center, San Antonio, Texas
| | - Ishak A Mansi
- Department of Internal Medicine, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
16
|
Cicero AF, Derosa G, Parini A, Baronio C, Borghi C. Factors associated with 2-year persistence in fully non reimbursed lipid-lowering treatments. Atherosclerosis 2014; 235:81-3. [DOI: 10.1016/j.atherosclerosis.2014.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/09/2014] [Accepted: 04/07/2014] [Indexed: 01/05/2023]
|