1
|
Mazhar F, Hjemdahl P, Clase CM, Johnell K, Jernberg T, Carrero JJ. Lipid-lowering treatment intensity, persistence, adherence and goal attainment in patients with coronary heart disease. Am Heart J 2022; 251:78-90. [PMID: 35654163 DOI: 10.1016/j.ahj.2022.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND To examine patterns of lipid-lowering therapy (LLT) use, and persistence and adherence among patients with coronary heart disease and their associations with lipoprotein cholesterol (LDL-C) goal attainment. METHODS Observational study among 26,768 patients who had suffered a myocardial infarction or had been revascularized in Stockholm during 2012 to 2018, and followed up through 2019. Outcomes included initiation of LLT, discontinuation, re-initiation, adherence to treatment and LDL-C goal attainment according to the European dyslipidaemia guidelines from 2011 and 2016 (mainly LDL-C <1.8 mmol/L). RESULTS 82% of patients commenced or continued LLT within 90 days after discharge. Of those, 71% were dispensed an LLT prescription within 30 days (62% of them for high-intensity LLT). High-intensity LLT prescribing increased over time, from 12% in 2012 to 78% in 2018. During a median follow-up of 3 (IQR 2-5) years 73% continued to fill prescriptions for a statin, 26.3% temporarily or permanently discontinued, and 0.5% changed to non-statin LLT. Only 1.3% discontinued statin treatment permanently. Throughout observation, about 80% of patients showed good statin adherence (proportion of days covered ≥80%). LDL-C target attainment was 52% the first year and <50% during subsequent years. LDL-C goal attainment was highest among patients receiving high-intensity statin treatment and showing good treatment adherence. CONCLUSION In secondary prevention for patients with established coronary heart disease, the proportion of LDL-C target attainment was low throughout the time period of the study, despite increasing use of high-intensity LLT and good treatment persistence and adherence.
Collapse
Affiliation(s)
- Faizan Mazhar
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institute and Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Catherine M Clase
- Department of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Ontario, Canada
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital (T.J.), Karolinska Institute, Stockholm, Sweden
| | - Juan Jesus Carrero
- Department of Clinical Sciences, Danderyd University Hospital (T.J.), Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
2
|
Statin discontinuation in persons with and without Alzheimer's disease. Eur J Clin Pharmacol 2022; 78:1145-1153. [PMID: 35449421 PMCID: PMC9184400 DOI: 10.1007/s00228-022-03320-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/12/2022] [Indexed: 12/04/2022]
Abstract
Background Although statin use is reported to decrease after dementia diagnosis, time to statin discontinuation and factors associated with discontinuation have not been studied in persons with Alzheimer’s disease (AD). We compared the risk of discontinuation and factors associated with discontinuation, including secondary and primary prevention indication, in statin users with and without AD. Methods The register-based Medication Use and Alzheimer’s Disease (MEDALZ) cohort includes community dwellers with a clinically verified AD diagnosed during 2005–2011 in Finland. On the AD diagnosis date (index date), each person with AD was matched with a comparison person without AD. We included 25,137 people with AD and 22,692 without AD who used statin on the index date or initiated within 90 days after. Cox regression models restricted to 4-year follow-up were conducted. Result The median time to statin discontinuation was 1.46 years in people with AD and 1.36 years in people without AD. People with AD were more likely to discontinue than people without AD (adjusted HR (aHR) 1.20 (95% CI 1.18–1.24)). This was observed for both primary (aHR 1.11 (1.06–1.16)) and secondary prevention (aHR 1.30 (1.25–1.35)) purpose. Factors associated with discontinuation included higher age and female gender, whereas concomitant cardiovascular drug use and previous statin use were associated with decreased risk. Conclusion The absolute difference in discontinuation rates was small, and the same factors were associated with statin discontinuation in people with and without AD. The findings suggest that cognitive decline plays a minor role on statin discontinuation. Supplementary information The online version contains supplementary material available at 10.1007/s00228-022-03320-3.
Collapse
|
3
|
Skov J, Falhammar H, Calissendorff J, Lindh JD, Mannheimer B. Association between lipid-lowering agents and severe hyponatremia: a population-based case-control study. Eur J Clin Pharmacol 2021; 77:747-755. [PMID: 33215235 PMCID: PMC8032630 DOI: 10.1007/s00228-020-03006-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Drug-induced hyponatremia is common, with medications from many drug-classes implicated. Lipid-lowering agents are among the most prescribed drugs. Limited evidence suggests an inverse association between statins and hyponatremia, while data on other lipid-lowering agents is absent. The objective of this investigation was to study the association between lipid-lowering drugs and hospitalization due to hyponatremia. METHODS This was a register-based case-control study of the general Swedish population. Those hospitalized with a main diagnosis of hyponatremia (n = 11,213) were compared with matched controls (n = 44,801). Multivariable logistic regression adjusting for co-medication, diseases, previous hospitalizations, and socioeconomic factors was used to explore the association between severe hyponatremia and the use of lipid-lowering drugs. RESULTS Unadjusted ORs (95% CI) for hospitalization due to hyponatremia were 1.28 (1.22-1.35) for statins, 1.09 (0.79-1.47) for ezetimibe, 1.38 (0.88-2.12) for fibrates, and 2.12 (1.31-3.35) for resins. After adjustment for confounding factors the adjusted odds ratios (95% CI) compared with controls were 0.69 (0.64-0.74) for statins, 0.60 (0.41-0.86) for ezetimibe, 0.87 (0.51-1.42) for fibrates, and 1.21 (0.69-2.06) for resins. CONCLUSIONS Use of statins and ezetimibe was inversely correlated with severe hyponatremia. Consequently, these drugs are unlikely culprits in patients with hyponatremia, and they appear safe to initiate in hyponatremic patients. A potential protective effect warrants further studies on how statins and other lipid-lowering drugs are linked to dysnatremias.
Collapse
Affiliation(s)
- Jakob Skov
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Karlstad Central Hospital, Karlstad, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Calissendorff
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - Jonatan D Lindh
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Buster Mannheimer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
4
|
Horsburgh S, Sharples K, Barson D, Zeng J, Parkin L. Patterns of metformin monotherapy discontinuation and reinitiation in people with type 2 diabetes mellitus in New Zealand. PLoS One 2021; 16:e0250289. [PMID: 33882106 PMCID: PMC8059805 DOI: 10.1371/journal.pone.0250289] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
Aim To describe the patterns of discontinuation and reinitiation in new users of metformin monotherapy in New Zealand, overall and according to person- and healthcare-related factors. Materials and methods We created a cohort (n = 85,066) of all patients in New Zealand with type 2 diabetes mellitus who initiated metformin monotherapy between 1 January 2006 and 30 September 2014 from the national data collections, and followed them until the earlier of their death or 31 December 2015. Discontinuation was defined as a gap in possession of metformin monotherapy of ≥90 days. We explored patterns of discontinuation and reinitiation using competing risks methods. Results After 1 year of follow-up, 28% of cohort members had discontinued metformin monotherapy at least once; the corresponding figures after 2 and 5 years were 37% and 46%. The proportions who reinitiated metformin monotherapy within 1, 2, and 5 years of their first discontinuation were 23%, 49%, and 73%. Discontinuation after the first reinitiation was common (48% after 1 year). Discontinuation and reinitiation varied by age, ethnicity, and other person- and healthcare-related factors. Discussion Our findings highlight the dynamic nature of metformin monotherapy use, show that substantial periods of non-use are common, and identify priority populations for interventions to facilitate adherence.
Collapse
Affiliation(s)
- Simon Horsburgh
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
- Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - David Barson
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Jiaxu Zeng
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Lianne Parkin
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Otago Medical School-Dunedin Campus, University of Otago, Dunedin, New Zealand
| |
Collapse
|
5
|
Boettiger DC, Kerr S, Chattranukulchai P, Siwamogsatham S, Avihingsanon A. Maintenance of statin therapy among people living with HIV. AIDS 2021; 35:567-574. [PMID: 33252492 DOI: 10.1097/qad.0000000000002769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Statins play a critical role in reducing the elevated risk of atherosclerotic cardiovascular disease (ASCVD) among people living with HIV (PLHIV). However, maintaining statin therapy is difficult and may be impeded further in PLHIV due to the risk of antiretroviral therapy (ART)/statin interactions. We estimated rates of statin discontinuation and reinitiation, and the percentage of days covered by statin use among PLHIV on ART, and investigated factors associated with these outcomes. DESIGN Observational cohort study. METHODS Clinical data from individuals attending the HIV-NAT Centre in Bangkok, Thailand between 2001 and 2020 were analyzed using Kaplan-Meier curves, competing-risk regression, and generalized estimating equations. Discontinuation was defined as statin cessation lasting 90 days. RESULTS Data on 318 PLHIV were included. After 1, 3, and 5 years, 22.3, 50.8, and 61.1% had discontinued statin use, respectively. Among those who discontinued (n = 178), 52.0% reinitiated statin use within 5 years. Factors associated with statin discontinuation were low education level, fewer concomitant medications, and lack of ASCVD. Factors associated with statin reinitiation were older age, diabetes, and high levels of LDL cholesterol. The adjusted mean percentage of days covered by a statin was 86.7, 61.1, and 58.1% in the 6 months prior to 1, 3, and 5 years of follow-up, respectively. CONCLUSION Maintenance of statin therapy is poor among PLHIV on ART but is not associated with using contraindicated antiretroviral/statin combinations. A better understanding of statin use in PLHIV will aid clinicians treating individuals and policy makers designing interventions for population-level ASCVD risk reduction.
Collapse
Affiliation(s)
- David C Boettiger
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Institute for Health and Aging, University of California, San Francisco, San Francisco, California, USA
- Faculty of Medicine, Biostatistics Excellence Centre, Chulalongkorn University, King Chulalongkorn Memorial Hospital
| | - Stephen Kerr
- Faculty of Medicine, Biostatistics Excellence Centre, Chulalongkorn University, King Chulalongkorn Memorial Hospital
- HIV-NAT Research Collaboration/Thai Red Cross AIDS Research Centre
| | | | | | - Anchalee Avihingsanon
- HIV-NAT Research Collaboration/Thai Red Cross AIDS Research Centre
- Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
6
|
Wawruch M, Wimmer G, Murin J, Paduchova M, Petrova M, Tesar T, Matalova P, Havelkova B, Trnka M, Aarnio E. Non-Adherence to Statin Treatment in Older Patients with Peripheral Arterial Disease Depending on Persistence Status. Biomedicines 2020; 8:biomedicines8100378. [PMID: 32992971 PMCID: PMC7599852 DOI: 10.3390/biomedicines8100378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022] Open
Abstract
The effectiveness of statins in secondary prevention of peripheral arterial disease (PAD) largely depends on patients’ adherence to treatment. The aims of our study were: (a) to analyze non-adherence during the whole follow-up in persistent patients, and only during persistence for non-persistent patients; (b) to identify factors associated with non-adherence separately among persistent and non-persistent patients. A cohort of 8330 statin users aged ≥65 years, in whom PAD was newly diagnosed between January 2012–December 2012, included 5353 patients persistent with statin treatment, and 2977 subjects who became non-persistent during the 5-year follow-up. Non-adherence was defined using the proportion of days covered <80%. Patient- and statin-related characteristics associated with non-adherence were identified with binary logistic regression. A significantly higher proportion of non-adherent patients was found among non-persistent patients compared to persistent subjects (43.6% vs. 29.6%; p < 0.001). Associated with non-adherence in both persistent and non-persistent patients was high intensity statin treatment, while in non-persistent patients, it was employment and increasing number of medications. In patients with a poor adherence during their persistent period, an increased risk for discontinuation may be expected. However, there is also non-adherence among persistent patients. There are differences in factors associated with non-adherence depending on patients’ persistence.
Collapse
Affiliation(s)
- Martin Wawruch
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, 811 08 Bratislava, Slovakia;
- Correspondence: (M.W.); (T.T.)
| | - Gejza Wimmer
- Institute of Measurement Science, Slovak Academy of Sciences, 841 04 Bratislava, Slovakia;
| | - Jan Murin
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, 813 69 Bratislava, Slovakia;
| | | | - Miriam Petrova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, 811 08 Bratislava, Slovakia;
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, 832 32 Bratislava, Slovakia
- Correspondence: (M.W.); (T.T.)
| | - Petra Matalova
- Department of Pharmacology, Faculty of Medicine and Dentistry, Palacky University, 775 15 Olomouc, Czech Republic;
| | - Beata Havelkova
- General Health Insurance Company, 851 04 Bratislava, Slovakia;
| | - Michal Trnka
- Institute of Medical Physics, Biophysics, Informatics and Telemedicine, Faculty of Medicine, Comenius University, 813 72 Bratislava, Slovakia;
| | - Emma Aarnio
- Institute of Biomedicine, University of Turku, 20014 Turku, Finland;
- School of Pharmacy, University of Eastern Finland, 70211 Kuopio, Finland
| |
Collapse
|
7
|
Wawruch M, Wimmer G, Murin J, Paduchova M, Tesar T, Hlinkova L, Slavkovsky P, Aarnio E. Factors Associated with Reinitiation of Statin Treatment in Older Patients with Peripheral Arterial Disease. Drugs Aging 2020; 37:595-604. [PMID: 32514873 DOI: 10.1007/s40266-020-00772-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Long-term persistence represents a basic precondition of successful statin treatment in patients with peripheral arterial disease (PAD). OBJECTIVES The aims of our study were evaluation of reinitiation in older PAD patients who were non-persistent with statin treatment, and identification of patient-related characteristics associated with the patient's probability of reinitiation. METHODS Our study cohort included 2977 older patients (≥ 65 years) who were non-persistent with statin treatment in whom PAD was newly diagnosed in 2012. Reinitiation was defined as the first statin prescription recorded after discontinuation. To analyze factors associated with the patient´s probability of reinitiation, Cox regression with time-dependent covariates was applied. RESULTS After post-discontinuation follow-up of a mean of 27 months, reinitiation of statin treatment was recorded for 1244 (41.8%) patients. Increasing age, Parkinson's disease, being a new statin user (patient in whom statin treatment was initiated in association with PAD diagnosis), general practitioner as the index prescriber who prescribed a statin for the first time after diagnosis of PAD, coadministration of loop diuretics, and longer persistence before discontinuation decreased the patient's likelihood of reinitiation, whereas myocardial infarction during non-persistence, high-intensity statin treatment, and increasing number of medications increased the patient's probability of reinitiation. CONCLUSIONS In patients with characteristics associated with a lower probability of reinitiation, more concentrated outreach and further evaluation of these groups to identify interventions that might be helpful to encourage reinitiation are needed.
Collapse
Affiliation(s)
- Martin Wawruch
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08, Bratislava, Slovakia.
| | - Gejza Wimmer
- Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jan Murin
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Tomas Tesar
- Department of Organization and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Odbojarov 10, 832 32, Bratislava, Slovakia.
| | - Lubica Hlinkova
- General Health Insurance Company, Bratislava, Slovakia.,Institute for Healthcare Disciplines, St. Elizabeth College of Health and Social Work, Bratislava, Slovakia
| | - Peter Slavkovsky
- Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Emma Aarnio
- Institute of Biomedicine, University of Turku, Turku, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
8
|
Booth JN, Colantonio LD, Chen L, Rosenson RS, Monda KL, Safford MM, Kilgore ML, Brown TM, Taylor B, Dent R, Muntner P, Levitan EB. Statin Discontinuation, Reinitiation, and Persistence Patterns Among Medicare Beneficiaries After Myocardial Infarction: A Cohort Study. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.003626. [PMID: 29021332 DOI: 10.1161/circoutcomes.117.003626] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 09/14/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Although the benefits of statins accrue over time, treatment discontinuation is common. Examining the patterns of statin discontinuation, reinitiation, and persistence after reinitiation among Medicare beneficiaries after hospital discharge for a myocardial infarction may help increase statin use in high-risk patients. METHODS AND RESULTS Medicare beneficiaries with a statin fill claim within 30 days after hospital discharge for myocardial infarction in 2007 to 2012 (n=158 795) were followed for 182 days post-discharge to identify discontinuation, defined as 60 continuous days without statins available. Reinitiation, defined by a statin fill, was identified in the 365 days post-discontinuation. High persistence was defined as proportion of days covered ≥80% with ≥1 day of statin supply 182 days after reinitiation. Follow-up ended on December 31, 2014. In the 182 days after myocardial infarction hospital discharge, 15.4% of beneficiaries discontinued statins. Of this group, 53.7% reinitiated statins. On reinitiation, 27.1% changed statin type, 6.9% up-titrated intensity, 14.4% down-titrated intensity, and 66.0% had the same statin and intensity. In the 182 days after reinitiation, 45.8% had high persistence. Moderate- and high- versus low-intensity statins were associated with a lower risk for statin discontinuation (moderate intensity: relative risk [RR], 0.93; 95% confidence interval [CI], 0.89-0.96; high-intensity: RR, 0.95; 95% CI, 0.91-0.99). High persistence was less common after reinitiating high- versus low-intensity statins (RR, 0.80; 95% CI, 0.75-0.86), but no association was present for those reinitiating a moderate- versus low-intensity statin (RR, 0.95; 95% CI, 0.90-1.01). Down-titrating versus reinitiating the same statin intensity (RR, 1.10; 95% CI, 1.05-1.16) and reinitiating a different versus the same statin (RR, 1.10; 95% CI, 1.06-1.14) were associated with high persistence after treatment reinitiation. CONCLUSIONS Although many people who discontinue a statin reinitiate treatment, statin persistence after reinitiation was low. Reinitiating therapy with moderate-intensity statins, down-titration, and using a different statin may promote persistence.
Collapse
Affiliation(s)
- John N Booth
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| | - Lisandro D Colantonio
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| | - Ligong Chen
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| | - Robert S Rosenson
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| | - Keri L Monda
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| | - Monika M Safford
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| | - Meredith L Kilgore
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| | - Todd M Brown
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| | - Benjamin Taylor
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| | - Ricardo Dent
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| | - Paul Muntner
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| | - Emily B Levitan
- From the Department of Epidemiology (J.N.B., L.D.C., L.C., P.M., E.B.L.), Department of Health Care Organization and Policy (M.L.K.), and Department of Medicine (T.M.B), University of Alabama at Birmingham, AL; Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY (R.S.R.); Center for Observational Research (K.L.M., B.T.) and Global Development (R.D.), Amgen Inc., Thousand Oaks, CA; and Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.)
| |
Collapse
|
9
|
Ofori-Asenso R, Zoungas S, Liew D. Reinitiation of Statin Therapy After Discontinuation: A Meta-analysis. Mayo Clin Proc 2018; 93:666-668. [PMID: 29728206 DOI: 10.1016/j.mayocp.2018.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/09/2018] [Indexed: 11/23/2022]
|
10
|
Levy AE, Ho PM. Nonadherence in the Learning Healthcare System: Avoiding a Mountain by Seeing the Bumps. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.117.004283. [PMID: 29021335 DOI: 10.1161/circoutcomes.117.004283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew E Levy
- From the Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (A.E.L.); and VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver (P.M.H.)
| | - P Michael Ho
- From the Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (A.E.L.); and VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver (P.M.H.).
| |
Collapse
|
11
|
Zafrir B, Jubran A, Lavie G, Halon DA, Flugelman MY, Shapira C. Clinical determinants and treatment gaps in familial hypercholesterolemia: Data from a multi-ethnic regional health service. Eur J Prev Cardiol 2017; 24:867-875. [PMID: 28186442 DOI: 10.1177/2047487317693132] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Familial hypercholesterolemia is characterized by markedly increased low-density lipoprotein cholesterol and risk for premature atherosclerotic cardiovascular disease. Models of care vary and reflect differing health policies and resources. The availability of electronic databases may enable better identification and assessment of familial hypercholesterolemia in the community. Methods A regional healthcare database was utilized to identify patients with a high probability of familial hypercholesterolemia, clinically defined by age-dependent-peak low-density lipoprotein cholesterol cutoffs and exclusion of secondary causes of severe hypercholesterolemia. Clinical characteristics, low-density lipoprotein cholesterol goal attainment, and treatment gaps were investigated. Results Probable familial hypercholesterolemia was diagnosed in 1932 of 685,314 individuals (1:355; median age 47 years). Atherosclerotic cardiovascular disease was present in 16.3% of adults (38% in males aged 50-74 years). Median peak low-density lipoprotein cholesterol was 264 mg/dl (interquartile range 252-288). Statins and/or ezetimibe were prescribed to 83% of patients and high-intensity statins to 53%, whereas prescriptions were filled in 57% and 40% cases respectively over the last six months, p < 0.001. Treatment gaps were wider among ethnic minorities, younger individuals, and those without atherosclerotic cardiovascular disease. Low-density lipoprotein cholesterol < 100 mg/dl was attained in 10.1% overall and 28.7% of those with atherosclerotic cardiovascular disease. Predictors of low-density lipoprotein cholesterol goal attainment included recent issue of high-intensity statins, presence of atherosclerotic cardiovascular disease, diabetes, older age and lack of smoking. Conclusions The population with high probability for familial hypercholesterolemia was characterized by low attainment of low-density lipoprotein cholesterol treatment goals despite high prescription rates of lipid-lowering medications. Low utilization of intensified therapies, non-adherence, and ethnic disparities were contributing factors. These findings emphasize the need to improve awareness and quality of care of familial hypercholesterolemia in the community.
Collapse
Affiliation(s)
- Barak Zafrir
- 1 Department of Cardiology, Lady Davis Carmel Medical Center, Israel
| | - Ayman Jubran
- 1 Department of Cardiology, Lady Davis Carmel Medical Center, Israel
| | - Gil Lavie
- 2 Department of Medicine, Lady Davis Carmel Medical Center, Israel
| | - David A Halon
- 1 Department of Cardiology, Lady Davis Carmel Medical Center, Israel
| | - Moshe Y Flugelman
- 1 Department of Cardiology, Lady Davis Carmel Medical Center, Israel
| | - Chen Shapira
- 3 Clalit Health Services, Haifa and Western Galilee District, Israel
| |
Collapse
|
12
|
Abstract
More than 13 million Americans are taking statin drugs in order to lower cholesterol levels and thereby avoid potential cardiovascular disease. Home healthcare clinicians are well suited to educate patients about this sometimes-controversial medication class. The purpose of this article is to describe the link between cholesterol and statins, and to provide an overview for healthcare providers including drug actions, indications, and possible adverse effects.
Collapse
Affiliation(s)
- Diana R Mager
- Diana R. Mager, DNP, RN-BC, is an Associate Professor, Fairfield University School of Nursing, Fairfield, Connecticut
| |
Collapse
|
13
|
Halava H, Huupponen R, Pentti J, Kivimäki M, Vahtera J. Predictors of first-year statin medication discontinuation: A cohort study. J Clin Lipidol 2016; 10:987-995. [PMID: 27578131 PMCID: PMC5012887 DOI: 10.1016/j.jacl.2016.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/26/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The discontinuation of statin medication is associated with an increased risk of cardiovascular and cerebrovascular events and, among high-risk patients, all-cause mortality, but the reasons for discontinuation among statin initiators in clinical practice are poorly understood. OBJECTIVE To examine factors predicting the early discontinuation of statin therapy. METHODS In this prospective cohort study, participants with baseline measurements before the initiation of statin treatment were linked to national registers and followed for the discontinuation of statins during the first year of treatment (no filled prescriptions after statin initiation within the subsequent 12 months). RESULTS Of all the 9285 statin initiators, 12% (n = 1142) were discontinuers. Obesity, overweight, vascular comorbidities, and older age were independently associated with a reduced risk of discontinuation [odds ratios (OR) = 0.82 (95% confidence interval [CI], 0.69-0.99), 0.85 (95% CI, 0.73-0.98), 0.80 (95% CI, 0.68-0.93), and 0.82 (95% CI, 0.68-0.99), respectively]. In contrast, high-patient cost-sharing was associated with an increased odds (OR = 1.29; 95% CI, 1.03-1.62) for discontinuation. The only significant difference between the sexes (P = .002) was observed among the participants with risky alcohol use, which was associated with a decreased odds for discontinuation among the men (OR = 0.69; 95% CI, 0.49-0.98) and an increased odds among the women (OR = 1.28; 95% CI, 1.02-1.62). CONCLUSIONS The discontinuation of statin therapy during the first year after initiation is common. Lowering out-of-pocket expenditures and focusing on low-risk patient groups and women with risky alcohol use could help maintain the continuation of medication.
Collapse
Affiliation(s)
- Heli Halava
- Department of Public Health, University of Turku, Turku, Finland.
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland; Tykslab, Turku University Hospital, Turku, Finland
| | - Jaana Pentti
- Finnish Institute of Occupational Health, Turku, Finland
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College of London, London, UK; Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland; Finnish Institute of Occupational Health, Turku, Finland; Turku University Hospital, Turku, Finland
| |
Collapse
|
14
|
Lavikainen P, Helin-Salmivaara A, Eerola M, Fang G, Hartikainen J, Huupponen R, Korhonen MJ. Statin adherence and risk of acute cardiovascular events among women: a cohort study accounting for time-dependent confounding affected by previous adherence. BMJ Open 2016; 6:e011306. [PMID: 27259530 PMCID: PMC4893857 DOI: 10.1136/bmjopen-2016-011306] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Previous studies on the effect of statin adherence on cardiovascular events in the primary prevention of cardiovascular disease have adjusted for time-dependent confounding, but potentially introduced bias into their estimates as adherence and confounders were measured simultaneously. We aimed to evaluate the effect when accounting for time-dependent confounding affected by previous adherence as well as time sequence between factors. DESIGN Retrospective cohort study. SETTING Finnish healthcare registers. PARTICIPANTS Women aged 45-64 years initiating statin use for primary prevention of cardiovascular disease in 2001-2004 (n=42 807). OUTCOMES Acute cardiovascular event defined as a composite of acute coronary syndrome and acute ischaemic stroke was our primary outcome. Low-energy fractures were used as a negative control outcome to evaluate the healthy-adherer effect. RESULTS During the 3-year follow-up, 474 women experienced the primary outcome event and 557 suffered a low-energy fracture. The causal HR estimated with marginal structural model for acute cardiovascular events for all the women who remained adherent (proportion of days covered ≥80%) to statin therapy during the previous adherence assessment year was 0.78 (95% CI: 0.65 to 0.94) when compared with everybody remaining non-adherent (proportion of days covered <80%). The result was robust against alternative model specifications. Statin adherers had a potentially reduced risk of experiencing low-energy fractures compared with non-adherers (HR 0.90, 95% CI 0.76 to 1.07). CONCLUSIONS Our study, which took into account the time dependence of adherence and confounders, as well as temporal order between these factors, is support for the concept that adherence to statins in women in primary prevention decreases the risk of acute cardiovascular events by about one-fifth in comparison to non-adherence. However, part of the observed effect of statin adherence on acute cardiovascular events may be due to the healthy-adherer effect.
Collapse
Affiliation(s)
- Piia Lavikainen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Drug Research Doctoral Programme, University of Turku, Turku, Finland
| | - Arja Helin-Salmivaara
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Unit of Primary Health Care, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Mervi Eerola
- The Center of Statistics, University of Turku, Turku, Finland
| | - Gang Fang
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Turku, Finland
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
15
|
Arnet I, Kooij MJ, Messerli M, Hersberger KE, Heerdink ER, Bouvy M. Proposal of Standardization to Assess Adherence With Medication Records: Methodology Matters. Ann Pharmacother 2016; 50:360-8. [PMID: 26917817 DOI: 10.1177/1060028016634106] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Medication adherence is the process by which patients take their medication as prescribed and is an umbrella term that encompasses all aspects of medication use patterns. Ambiguous terminology has emerged to describe a deviation from prescribed regimen, forcing the European ABC Project to define 3 phases of medication use: initiation, implementation, and discontinuation. However, different measures of medication adherence using medication records are currently available that do not always distinguish between these phases. The literature is lacking standardization and operationalization of the assessment methods. OBJECTIVE To propose a harmonization of standards as well as definitions of distinct measures and their operationalization to quantify adherence to medication from medication records. METHODS Group discussions and consensus process among all coauthors. The propositions were generated using the authors' experiences and views in the field of adherence, informed by theory. RESULTS The concepts of adherence measures within the new taxonomy were harmonized, and the standards necessary for the operationalization of adherence measures from medication records are proposed. Besides percentages and time-to values, the addition of a dichotomous value for the reinitiation of treatment is proposed. Methodological issues are listed that should be disclosed in studies on adherence. CONCLUSIONS The possible impact of the measures in adherence research is discussed. By doing this, the results of future adherence research should gain in accuracy. Finally, studies will become more transparent, enabling comparison between studies.
Collapse
|
16
|
Trentman TL, Avey SG, Ramakrishna H. Current and emerging treatments for hypercholesterolemia: A focus on statins and proprotein convertase subtilisin/kexin Type 9 inhibitors for perioperative clinicians. J Anaesthesiol Clin Pharmacol 2016; 32:440-445. [PMID: 28096572 PMCID: PMC5187606 DOI: 10.4103/0970-9185.194773] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Statins are a mainstay of hyperlipidemia treatment. These drugs inhibit the enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase and have beneficial effects on atherosclerosis including plaque stabilization, reduction of platelet activation, and reduction of plaque proliferation and inflammation. Statins also have a benefit beyond atherosclerotic plaque, including anticoagulation, vasodilatation, antioxidant effects, and reduction of mediators of inflammation. In the perioperative period, statins appear to contribute to improved outcomes via these mechanisms. Both vascular and nonvascular surgery patients have been shown in prospective studies to have lower risk of adverse cardiac outcomes when initiated on statins preoperatively. However, not all patients can tolerate statins; the search for novel lipid-lowering therapies led to the discovery of the proprotein convertase subtilisin/kexin Type 9 (PCSK9) inhibitors. These drugs are fully-humanized, injectable monoclonal antibodies. With lower PCSK9 activity, low-density lipoprotein cholesterol (LDL-C) receptors are more likely to be recycled to the hepatocyte surface, where they serve to clear plasma LDL-C. Evidence from several prospective studies shows that these new agents can significantly lower LDL-C levels. While PCSK9 inhibitors offer hope of effective therapy for patients with familial hyperlipidemia or intolerance of statins, several important questions remain, including the results of long term cardiovascular outcome studies. The perioperative effects of new LDL-C-lowering drugs are unknown at present but are likely to be similar to the older agents.
Collapse
Affiliation(s)
| | - Steven G Avey
- MedImpact Healthcare Systems, Inc, San Diego CA, USA
| | | |
Collapse
|
17
|
Ruokoniemi P, Sund R, Arffman M, Helin-Salmivaara A, Huupponen R, Keskimäki I, Vehko T, Korhonen MJ. Are statin trials in diabetes representative of real-world diabetes care: a population-based study on statin initiators in Finland. BMJ Open 2014; 4:e005402. [PMID: 24948750 PMCID: PMC4067810 DOI: 10.1136/bmjopen-2014-005402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/28/2014] [Accepted: 05/30/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the representativeness of the Heart Protection Study (HPS) and the Collaborative Atorvastatin Diabetes Study (CARDS) for incident statin users. DESIGN A population-based analysis with linked register data. SETTING Finland. POPULATION 56 963 patients with diabetes initiating statin use from 2005 to 2008. MAIN OUTCOME MEASURES We determined the proportions of real-world patients who fulfilled the eligibility criteria for HPS and CARDS trials and assessed the cardiovascular disease (CVD) event rates, assumed to reflect the background CVD risk, for those eligible and ineligible. We used descriptive statistics to identify the patient characteristics, lipid-lowering interventions and adherence to statin therapy. RESULTS Of the real-world patients, 57% (N=32 582) fulfilled the eligibility criteria for HPS (DM) and 49% (N=20 499) of those without CVD for CARDS. The patients ineligible for HPS (DM) had a higher cumulative risk for CVD events than those eligible, whereas regarding CARDS the cumulative risks were of similar magnitude. The overall CVD event rates seemed to be comparable to those in the reviewed trials. Both trials were under-representative of women and users of antihypertensive agents and metformin. 27% and 29% of real-world patients had an initial statin dose corresponding to <20 mg of simvastatin. The proportions of patients who were deemed adherent were 57% in the real world and 85% in both trials. CONCLUSIONS Only half of the real-world patients would have qualified for the HPS (DM) and CARDS, limiting their representativeness for clinical practice. Women and users of antihypertensive agents and metformin were under-represented in both trials. These deviations reflect the changes in diabetes treatment over the years and are not expected to modify the average treatment effects of statins on CVD. Prescribing of lower statin doses in clinical practice than used in the trials and lower adherence may, however, attenuate the benefits in the real world.
Collapse
Affiliation(s)
- Päivi Ruokoniemi
- Department of Pharmacology, Drug Development and Therapeutics, FI-20014 University of Turku, Turku, Finland
| | - Reijo Sund
- Service Systems Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Martti Arffman
- Service Systems Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Arja Helin-Salmivaara
- Department of Pharmacology, Drug Development and Therapeutics, FI-20014 University of Turku, Turku, Finland
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, FI-20014 University of Turku, Turku, Finland
- Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - Ilmo Keskimäki
- Social and Health Services, National Institute for Health and Welfare, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Tuulikki Vehko
- Service Systems Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, FI-20014 University of Turku, Turku, Finland
| |
Collapse
|
18
|
Upmeier E, Korhonen MJ, Rikala M, Helin-Salmivaara A, Huupponen R. Older Statin Initiators in Finland—Cardiovascular Risk Profiles and Persistence of Use. Cardiovasc Drugs Ther 2014; 28:263-72. [DOI: 10.1007/s10557-014-6517-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
19
|
Aarnio EJ, Martikainen JA, Helin-Salmivaara A, Huupponen RK, Hartikainen JE, Peura PK, Korhonen MJ. Register-based predictors of adherence among new statin users in Finland. J Clin Lipidol 2014; 8:117-25. [DOI: 10.1016/j.jacl.2013.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/12/2013] [Accepted: 09/25/2013] [Indexed: 11/17/2022]
|
20
|
Rikala M, Huupponen R, Helin-Salmivaara A, Korhonen MJ. Channelling of Statin Use towards Low-Risk Population and Patients with Diabetes. Basic Clin Pharmacol Toxicol 2013; 113:173-8. [DOI: 10.1111/bcpt.12075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/21/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Maria Rikala
- Department of Pharmacology, Drug Development and Therapeutics; University of Turku; Turku; Finland
| | | | | | | |
Collapse
|
21
|
Tomasik T, Windak A, Seifert B, Kersnik J, Kijowska V, Dubas K. Lipid-lowering pharmacotherapy in Central and Eastern European countries in cardiovascular prevention: self-reported prescription patterns of primary care physicians. J Cardiovasc Pharmacol Ther 2012; 18:234-42. [PMID: 23277158 DOI: 10.1177/1074248412471196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS The aims of this study were (1) to explore physicians' self-reported treatment of patients with dyslipidemia and (2) to identify intercountry differences and associations between physicians' characteristics and treatment patterns. METHODS A cross-sectional survey was performed in primary health care in 9 Central and Eastern European countries. An anonymous questionnaire, which included questions devoted to dyslipidemia treatment, was distributed. RESULTS A total of 3000 physicians were randomly chosen and 867 responded. The mean percentage of physicians in all countries who reported regular use of statins in primary prevention of cardiovascular diseases (CVD) was 86.4 (range between 91.0% of Polish physicians and 75.7% of Czech physicians; P < .01). In secondary prevention, the mean percentage was only a little higher, 89.9. The use of fibrates for primary prevention was reported by 40.3% of the respondents from Bulgaria and by 2% of the respondents from Estonia (P < .01). Also, significant differences between countries were found in the use of fibrates and combination therapy in secondary prevention. Atorvastatin and simvastatin were the most prescribed drugs in everyday practice (the mean percentage of physicians in all countries was 72.5% and 68.0%, respectively). More than three-fourth of the respondents reported prescribing lifelong treatment with statins. Inconsistent associations were found between the characteristics of physicians and their treatment patterns. CONCLUSIONS There are significant variations in the use of lipid-lowering drugs in Central and Eastern European countries; however, statin monotherapy predominates. Some physicians' decisions are made without supporting evidence from clinical trials. There is still scope to improve preventive care of CVD.
Collapse
Affiliation(s)
- Tomasz Tomasik
- Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland.
| | | | | | | | | | | |
Collapse
|
22
|
Statin use among older Finns stratified according to cardiovascular risk. Eur J Clin Pharmacol 2012; 69:261-7. [PMID: 22706622 DOI: 10.1007/s00228-012-1328-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 05/28/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Statin use has increased in older age groups, although there is little evidence for the benefits of statin therapy in the elderly, especially in low-risk persons. The aim of this paper is to describe recent trends in the prevalence and incidence of statin use among the Finnish older population, according to the person's estimated cardiovascular (CV) event risk. METHODS We conducted a register study covering the whole community-dwelling population of Finland, aged >70 years in 2000-2008 (N = 883,051). Data on reimbursed purchases of statins, antidiabetic and CV drugs, and pre-existing CV diseases were retrieved from comprehensive national registers. We stratified each person into low, moderate or high CV risk category, and according to age (70-74, 75-79, and >80 years) and sex. RESULTS Between 2000 and 2008, the age-sex-standardized prevalence of statin use tripled from 12.2 % to 38.7 % (rate ratio 3.0, 95 % CI 3.0-3.1), and the incidence almost doubled (from 3.7 % to 6.8 %; rate ratio 1.8, 95 % CI 1.8-1.9). The prevalence and incidence of statin use were consistently highest among high-risk persons. The greatest relative increases were observed in persons aged >80 years and in those at low risk; however, the proportion of statin users at low CV risk remained the same (∼7 % of all users). CONCLUSIONS Statin prescribing is shifting towards older age groups. A substantial increase in prevalence and incidence was seen across all risk categories, but the channeling of statin use towards high-risk persons remained unchanged.
Collapse
|
23
|
Abstract
Despite the widespread prescription of highly effective lipid-lowering medications, such as the HMG-CoA reductase inhibitors (statins), a large portion of the population has lipid levels higher than the recommended goals. Treatment failures have been attributed to a variety of causes but the most important is likely to be poor adherence to therapy in the form of irregular or interrupted intake and the high frequency of discontinuation or lack of persistence. Adherence is a multidimensional phenomenon determined by the interplay of patient factors, physician factors, and health care system factors. Patients' knowledge and beliefs about their illness, motivation to manage it, confidence in their ability to engage in illness-management behaviors, and expectations regarding the outcome of treatment and the consequences of poor adherence interact to influence adherence behavior. Patient-related factors account for the largest incremental explanatory power in predicting adherence. This article provides an overview of this critical issue, focusing on patient role in determining adherence level to lipid-lowering therapy.
Collapse
Affiliation(s)
- Manuela Casula
- Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological Sciences, University of Milan, Milan, Italy
| | - Elena Tragni
- Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological Sciences, University of Milan, Milan, Italy
- Correspondence: Elena Tragni, Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133 Milan, Italy, Tel +39 02 5031 8259, Fax +39 02 5031 8292, Email
| | - Alberico Luigi Catapano
- Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological Sciences, University of Milan, Milan, Italy
- IRCCS MultiMedica, Sesto San Giovanni, Italy
| |
Collapse
|