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Kim KS, Hong S, Han K, Park CY. Clinical Characteristics of Patients With Statin Discontinuation in Korea: A Nationwide Population-Based Study. J Lipid Atheroscler 2024; 13:41-52. [PMID: 38299165 PMCID: PMC10825567 DOI: 10.12997/jla.2024.13.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/05/2023] [Accepted: 11/06/2023] [Indexed: 02/02/2024] Open
Abstract
Objective To investigate the clinical characteristics of patients with statin discontinuation in Korea, using a nationwide database. Methods We analyzed 1,308,390 patients treated with statin for the first time in their life between 2016 and 2017 using the Korean National Health Information Database. The patients participated in the Korean National Health Screening Program within two years before taking statin. Patients with statin discontinuation were defined as those who were not prescribed statin between 365 days and 730 days after the initial statin prescription. Results The overall prevalence of statin discontinuation was 39.44%. Patients with statin discontinuation were younger, had lower body mass index (BMI), included a higher number of smokers and drinkers, did not exercise regularly, with fewer cases of hypertension and diabetes mellitus than those without statin discontinuation (p<0.001). Compared with patients aged 20-29 years, the risk of statin discontinuation showed a U-shaped relationship with age (odds ratios [ORs]: 0.619 in 30-39 years; 0.454 in 40-49 years; 0.345 in 50-59 years; 0.307 in 60-69 years; 0.324 in 70-79 years; and 0.415 in ≥80 years). In addition, increased BMI was associated with decreased risk of statin discontinuation (ORs: 0.969 with 25.0-29.9 kg/m2, and 0.890 with ≥30.0 kg/m2). Patients with hypertension and diabetes mellitus were at a lower risk of statin discontinuation (OR: 0.414 for hypertension; 0.416 for diabetes mellitus). Conclusion The prevalence of patients with statin discontinuation in Korea was 39.44% at 1 to 2 years after initial statin treatment.
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Affiliation(s)
- Kyung-Soo Kim
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Sangmo Hong
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Cheol-Young Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Said AH, Abd Rahim IS, Mohamad Zaini NNB, Saiful Nizam NIB. Factors Affecting Adherence to Lipid-lowering Drugs: A Scoping Review. Oman Med J 2023; 38:e523. [PMID: 37736054 PMCID: PMC10509635 DOI: 10.5001/omj.2023.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/13/2022] [Indexed: 09/02/2023] Open
Abstract
Objectives Dyslipidemia is an important risk factor for cardiovascular disease. In developed countries, only 50% of patients with chronic illness adhere to their long-term therapy. This article aimed to review the factors affecting adherence to lipid-lowering drugs (LLDs). Methods The searched articles were selected based on the available keywords in the title and abstract with the publication restricted between January 2010 and September 2020. Articles generated from the databases must fulfill both inclusion and exclusion criteria in the present systematic review. Our initial search retrieved 221 literature reviews. After excluding articles with irrelevant topics, a total of 23 articles were chosen for this current review. Results The factors were classified based on three main factors: patient-related, medication-related, and healthcare workers-related factors. For patient-related factors, gender, age, number of family members, education level, post-hospitalization, comorbidities and cardiovascular disease risk, follow-up status, occupation, socio-economy, insurance, perception, ethnicity, and health plan were among the factors affecting adherence to LLDs. As for medication-related factors, timing, polypharmacy, duration of treatment, generic medication, intensity of medication, side effects, initiating dose, packaging, drug dosing, and type of drugs were revealed as contributing factors. In the light of healthcare workers, related factors shown were counseling, medication optimization, type of provider, and location of the hospital. Conclusions Recommendations to improve adherence include educating patients on the disease itself and the importance of the treatment, modification of the dosing, timing and type of LLDs, and effective consultations by healthcare workers. Further studies need to be done in Malaysia as there is inadequate research on this topic.
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Affiliation(s)
- Abdul Hadi Said
- Department of Family Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Selangor, Malaysia
| | - Ikhlas Solehah Abd Rahim
- Department of Family Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Selangor, Malaysia
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Aljofan M, Oshibayeva A, Moldaliyev I, Saruarov Y, Maulenkul T, Gaipov A. The rate of medication nonadherence and influencing factors: A systematic Review. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Lack of adherence to recommended therapy will reduce its effectiveness and can subsequently lead to disease progression, disabilities or even death. A vast number of research studies have emphasized the magnitude of medication nonadherence and its effect on treatment outcomes, patient’s health, healthcare providers and the associated costs; medication nonadherence remains a major concern that is believed to be widely practiced amongst medication taking patients. The current systemic review aims to cohere the available evidence regarding medication nonadherence rate, practices, and potential affecting factors and predictors. A search through different databases was conducted, including PubMed, Medline, and CINHAL for recently published research articles, within five years. The terms used for the search include medication nonadherence, medication nonadherence, factors affecting medication nonadherence and predictors of medication nonadherence. The search was limited to human subjects, English language journal articles and exclusion of review articles, case studies, and data from clinical trials as patient adherence is closely observed.<br />
The search resulted in 667 articles and only 65 articles were included and further screened. However, according to our exclusion criteria, 15 articles only were included in this review. The three most reported practices of medication nonadherence are prescription abandonment, nonconforming, and non-persistence. There are five reported factors that may lead to nonadherence practices such as socioeconomic-related factors, healthcare system-related factors, patient-related factors, disease-related factors, and therapy-related factors. In conclusion, medication nonadherence practice is a multi-dimensional phenomenon that requires a multi-targeted solution.
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Affiliation(s)
- Mohamad Aljofan
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, KAZAKHSTAN
| | - Ainash Oshibayeva
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Ikilas Moldaliyev
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Yerbolat Saruarov
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Tilektes Maulenkul
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Abduzhappar Gaipov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, KAZAKHSTAN
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Haskiah F, Khaskia A. Lipid treatment status and goal attainment among patients with premature acute coronary syndrome in Israel. J Clin Lipidol 2023; 17:367-375. [PMID: 37120357 DOI: 10.1016/j.jacl.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND There are significant health gaps between Arabs and Jews in Israel. However, there are limited data on the management and treatment of dyslipidemia among Israeli adults who experience premature acute coronary syndrome (ACS). This study aimed to assess the differences between Arabs and Jews with regard to lipid-lowering therapy administration and low-density lipoprotein cholesterol (LDL-C) levels goal attainment at 1 year post-ACS. METHODS This study included patients aged ≤55 years who had been hospitalized for ACS at Meir Medical Center between 2018 and 2019. Outcomes included the rate of use of lipid-lowering medications, LDL-C levels 1 year post-admission, and major adverse cardiovascular and cerebrovascular events (MACCE) during 30 months of follow-up. RESULTS The study population comprised 687 young adults with a median age of 48.5 years. 81.9% of the Arab patients and 79.8% of the Jewish patients were discharged on high intensity statins. At 1 year of follow-up, the proportions of Arab patients who had LDL-C levels <70 mg/dL and <55 mg/dL were lower than those of Jewish patients (43.8% vs. 58%, p < 0.001 and 34.5% vs. 45.3%, p < 0.001, respectively). At 1 year of follow-up, only 25% and 4% of both groups were treated with ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor. The incidence of MACCE was significantly higher among Arab patients. CONCLUSION Our study highlighted the need for a more aggressive lipid-lowering strategy in both Arab and Jewish populations. Culturally adapted interventions are required to reduce gaps between Arab and Jewish patients.
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Affiliation(s)
- Feras Haskiah
- Department of Internal Medicine D, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Abid Khaskia
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
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Use of bempedoic acid for LDL cholesterol lowering and cardiovascular risk reduction: a consensus document from the Italian study group on atherosclerosis, thrombosis and vascular biology. Vascul Pharmacol 2023; 148:107137. [PMID: 36464086 DOI: 10.1016/j.vph.2022.107137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
The clinical benefit of LDL cholesterol (LDL-C) lowering for cardiovascular disease prevention is well documented. This paper from the Italian Study Group on Atherosclerosis, Thrombosis and Vascular Biology summarizes current recommendations for treatment of hypercholesterolemia, barriers to lipid-lowering therapy implementation and tips to overcome them, as well as available evidence on the efficacy and safety of bempedoic acid. We also report an updated therapeutic algorithm for pharmacological LDL-C lowering in view of the introduction of bempedoic acid in clinical practice.
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Mahmood A, Nayak P, Deshmukh A, English C, N M, Solomon M J, B U. Measurement, determinants, barriers, and interventions for exercise adherence: A scoping review. J Bodyw Mov Ther 2023; 33:95-105. [PMID: 36775533 DOI: 10.1016/j.jbmt.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 05/21/2022] [Accepted: 09/18/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Adherence to exercise interventions is the cornerstone of a successful rehabilitation program. However, there is limited evidence on multifaceted components of exercise adherence. Therefore, we aimed to summarize the existing literature on measurement, determinants, barriers, theoretical frameworks, and evidence-based interventions that support exercise adherence. METHODS We conducted a scoping review based on the PRISMA extension for scoping reviews guidelines and searched the literature in PubMed, Cochrane Databases of Systematic Reviews, ScienceDirect, and Web of Science. Two reviewers independently screened articles. The included articles were subjected to data extraction and qualitative synthesis. RESULTS A total of 72 articles were included for this review. Data synthesis showed that there are no gold standard methods of measuring exercise adherence; however, questionnaires and daily logs are commonly used tools. The determinants of adherence are personal, disease-related, therapy-related, provider-related, and health system-related. The common barriers to adherence are the absence of a caregiver, low health literacy, poor communication by healthcare providers, cost, and lack of access to health facilities. Few evidence-based interventions used for supporting adherence are behavioral strategies, improving self-efficacy, motivational therapy, and mHealth or multimedia. CONCLUSION Non-adherence to exercises is a challenge for healthcare providers. There are no standard guidelines for the evaluation and management of non-adherence to exercises. Future studies should aim at developing objective measures of exercise adherence and investigate the long-term effects of adherence strategies in different disease populations. It is an under-researched area and requires multipronged strategies to improve adherence levels among patients.
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Affiliation(s)
- Amreen Mahmood
- Department of Health Professions, Manchester Metropolitan University, Birley Fields Campus, Bonsall Street, M15 6GX, Manchester, United Kingdom.
| | - Pradeepa Nayak
- Department of Health Professions, Manchester Metropolitan University, Birley Fields Campus, Bonsall Street, M15 6GX, Manchester, United Kingdom.
| | - Anagha Deshmukh
- Department of Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - Coralie English
- School of Health Sciences and Priority Research, Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia.
| | - Manikandan N
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - John Solomon M
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - Unnikrishnan B
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
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Hsu W, Warren J, Riddle P. Multivariate Sequential Analytics for Cardiovascular Disease Event Prediction. Methods Inf Med 2022; 61:e149-e171. [PMID: 36564011 PMCID: PMC9788915 DOI: 10.1055/s-0042-1758687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Automated clinical decision support for risk assessment is a powerful tool in combating cardiovascular disease (CVD), enabling targeted early intervention that could avoid issues of overtreatment or undertreatment. However, current CVD risk prediction models use observations at baseline without explicitly representing patient history as a time series. OBJECTIVE The aim of this study is to examine whether by explicitly modelling the temporal dimension of patient history event prediction may be improved. METHODS This study investigates methods for multivariate sequential modelling with a particular emphasis on long short-term memory (LSTM) recurrent neural networks. Data from a CVD decision support tool is linked to routinely collected national datasets including pharmaceutical dispensing, hospitalization, laboratory test results, and deaths. The study uses a 2-year observation and a 5-year prediction window. Selected methods are applied to the linked dataset. The experiments performed focus on CVD event prediction. CVD death or hospitalization in a 5-year interval was predicted for patients with history of lipid-lowering therapy. RESULTS The results of the experiments showed temporal models are valuable for CVD event prediction over a 5-year interval. This is especially the case for LSTM, which produced the best predictive performance among all models compared achieving AUROC of 0.801 and average precision of 0.425. The non-temporal model comparator ridge classifier (RC) trained using all quarterly data or by aggregating quarterly data (averaging time-varying features) was highly competitive achieving AUROC of 0.799 and average precision of 0.420 and AUROC of 0.800 and average precision of 0.421, respectively. CONCLUSION This study provides evidence that the use of deep temporal models particularly LSTM in clinical decision support for chronic disease would be advantageous with LSTM significantly improving on commonly used regression models such as logistic regression and Cox proportional hazards on the task of CVD event prediction.
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Affiliation(s)
- William Hsu
- School of Computer Science, University of Auckland, Auckland, New Zealand,Address for correspondence William Hsu, PhD School of Computer Science, University of AucklandPrivate Bag 92019, Auckland 1142New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Patricia Riddle
- School of Computer Science, University of Auckland, Auckland, New Zealand
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8
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Muacevic A, Adler JR, Ahmad S, Elnaggar MN, Allcock R, Ali S, Kyi NM, Salazar L, Gbegbaje A, Banerjee M. Protein Convertase Subtilisin/Kexin Type 9 Monoclonal Antibodies (PCSK9mab) in Clinical Practice at Secondary Care - Real World Multicentre Experience. Cureus 2022; 14:e33044. [PMID: 36721583 PMCID: PMC9881602 DOI: 10.7759/cureus.33044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Background and Aims Protein convertase subtilisin/Kexin type 9 monoclonal antibodies (PCSK9mab) are a novel addition to the therapeutic options for managing hyperlipidemia. Various guidelines have advocated the addition of these agents if the target low-density lipoprotein-cholesterol ( LDL-C) is not achieved by maximum lipid-lowering therapy. They have shown a robust and consistent reduction in LDL-C in clinical trials. However, the translation of these results in a real-world setting is limited and confined mainly to tertiary lipid centers. This service evaluation aimed to assess their efficacy in a real-world outpatient setting of secondary care centers. Methods Data was collected retrospectively from four hospitals in the North-West of England. Patients were required to attend a lipid clinic for follow-up investigations to continue with the prescription of PCSK9mab. Results A total of 175 patients were identified. Efficacy outcomes were measured in 169 patients. 6 discontinued the agent within 3 months of initiation and were excluded from the efficacy outcomes. 19.5% (n=33) had confirmed familial hypercholesterolemia. 61% (n=103) of the patients were intolerant to statins. 53.2% (n=90) of the patients have been prescribed Alirocumab. Mean LDL-C reduction was 50.6% at 6-month which was sustained at 48.9% at 12 months. There was no difference in % reduction of LDL-C between Alirocumab and Evolocumab. LDL-C reduction was more significant in patients who were on concomitant statins. 9.1% of patients experienced side effects, and 5.1% discontinued the PCSK9mab during treatment. Conclusion The efficacy of lipid reduction and the side effect profile of PCSK9mab from these secondary care services are similar to randomized clinical trials and real-world observational studies from tertiary lipid centers.
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Hsu W, Warren JR, Riddle PJ. Medication adherence prediction through temporal modelling in cardiovascular disease management. BMC Med Inform Decis Mak 2022; 22:313. [DOI: 10.1186/s12911-022-02052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022] Open
Abstract
Abstract
Background
Chronic conditions place a considerable burden on modern healthcare systems. Within New Zealand and worldwide cardiovascular disease (CVD) affects a significant proportion of the population and it is the leading cause of death. Like other chronic diseases, the course of cardiovascular disease is usually prolonged and its management necessarily long-term. Despite being highly effective in reducing CVD risk, non-adherence to long-term medication continues to be a longstanding challenge in healthcare delivery. The study investigates the benefits of integrating patient history and assesses the contribution of explicitly temporal models to medication adherence prediction in the context of lipid-lowering therapy.
Methods
Data from a CVD risk assessment tool is linked to routinely collected national and regional data sets including pharmaceutical dispensing, hospitalisation, lab test results and deaths. The study extracts a sub-cohort from 564,180 patients who had primary CVD risk assessment for analysis. Based on community pharmaceutical dispensing record, proportion of days covered (PDC) $$\ge$$
≥
80 is used as the threshold for adherence. Two years (8 quarters) of patient history before their CVD risk assessment is used as the observation window to predict patient adherence in the subsequent 5 years (20 quarters). The predictive performance of temporal deep learning models long short-term memory (LSTM) and simple recurrent neural networks (Simple RNN) are compared against non-temporal models multilayer perceptron (MLP), ridge classifier (RC) and logistic regression (LR). Further, the study investigates the effect of lengthening the observation window on the task of adherence prediction.
Results
Temporal models that use sequential data outperform non-temporal models, with LSTM producing the best predictive performance achieving a ROC AUC of 0.805. A performance gap is observed between models that can discover non-linear interactions between predictor variables and their linear counter parts, with neural network (NN) based models significantly outperforming linear models. Additionally, the predictive advantage of temporal models become more pronounced when the length of the observation window is increased.
Conclusion
The findings of the study provide evidence that using deep temporal models to integrate patient history in adherence prediction is advantageous. In particular, the RNN architecture LSTM significantly outperforms all other model comparators.
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Bytyçi I, Penson PE, Mikhailidis DP, Wong ND, Hernandez AV, Sahebkar A, Thompson PD, Mazidi M, Rysz J, Pella D, Reiner Ž, Toth PP, Banach M. Prevalence of statin intolerance: a meta-analysis. Eur Heart J 2022; 43:3213-3223. [PMID: 35169843 PMCID: PMC9757867 DOI: 10.1093/eurheartj/ehac015] [Citation(s) in RCA: 124] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/10/2022] [Indexed: 07/25/2023] Open
Abstract
AIMS Statin intolerance (SI) represents a significant public health problem for which precise estimates of prevalence are needed. Statin intolerance remains an important clinical challenge, and it is associated with an increased risk of cardiovascular events. This meta-analysis estimates the overall prevalence of SI, the prevalence according to different diagnostic criteria and in different disease settings, and identifies possible risk factors/conditions that might increase the risk of SI. METHODS AND RESULTS We searched several databases up to 31 May 2021, for studies that reported the prevalence of SI. The primary endpoint was overall prevalence and prevalence according to a range of diagnostic criteria [National Lipid Association (NLA), International Lipid Expert Panel (ILEP), and European Atherosclerosis Society (EAS)] and in different disease settings. The secondary endpoint was to identify possible risk factors for SI. A random-effects model was applied to estimate the overall pooled prevalence. A total of 176 studies [112 randomized controlled trials (RCTs); 64 cohort studies] with 4 143 517 patients were ultimately included in the analysis. The overall prevalence of SI was 9.1% (95% confidence interval 8.0-10%). The prevalence was similar when defined using NLA, ILEP, and EAS criteria [7.0% (6.0-8.0%), 6.7% (5.0-8.0%), 5.9% (4.0-7.0%), respectively]. The prevalence of SI in RCTs was significantly lower compared with cohort studies [4.9% (4.0-6.0%) vs. 17% (14-19%)]. The prevalence of SI in studies including both primary and secondary prevention patients was much higher than when primary or secondary prevention patients were analysed separately [18% (14-21%), 8.2% (6.0-10%), 9.1% (6.0-11%), respectively]. Statin lipid solubility did not affect the prevalence of SI [4.0% (2.0-5.0%) vs. 5.0% (4.0-6.0%)]. Age [odds ratio (OR) 1.33, P = 0.04], female gender (OR 1.47, P = 0.007), Asian and Black race (P < 0.05 for both), obesity (OR 1.30, P = 0.02), diabetes mellitus (OR 1.26, P = 0.02), hypothyroidism (OR 1.37, P = 0.01), chronic liver, and renal failure (P < 0.05 for both) were significantly associated with SI in the meta-regression model. Antiarrhythmic agents, calcium channel blockers, alcohol use, and increased statin dose were also associated with a higher risk of SI. CONCLUSION Based on the present analysis of >4 million patients, the prevalence of SI is low when diagnosed according to international definitions. These results support the concept that the prevalence of complete SI might often be overestimated and highlight the need for the careful assessment of patients with potential symptoms related to SI.
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Affiliation(s)
- Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo
| | - Peter E Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
| | - Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine School of Medicine Predictive Health Diagnostics, Irvine, CA, USA
| | - Adrian V Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, CT, USA
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Paul D Thompson
- Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, USA
- Department of Internal Medicine, University of Connecticut, Farmington, CT, USA
| | - Mohsen Mazidi
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, UK
- Department of Nutritional Sciences, King’s College London, London, UK
| | - Jacek Rysz
- Department of Hypertension, Nephrology and Family Medicine, Medical University of Lodz (MUL), Lodz, Poland
| | - Daniel Pella
- 2nd Department of Cardiology, Faculty of Medicine, Pavol Jozef Safarik University and East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Željko Reiner
- Department of Internal Diseases, University Hospital Center Zagreb, School of Medicine, Zagreb University, Zagreb, Croatia
| | - Peter P Toth
- CGH Medical Center, Sterling, IL, USA
- Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Golder S, Weissenbacher D, O’Connor K, Hennessy S, Gross R, Hernandez GG. Patient-Reported Reasons for Switching or Discontinuing Statin Therapy: A Mixed Methods Study Using Social Media. Drug Saf 2022; 45:971-981. [PMID: 35933649 PMCID: PMC9402720 DOI: 10.1007/s40264-022-01212-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/16/2022]
Abstract
Introduction Statin discontinuation can have major negative health consequences. Studying the reasons for discontinuation can be challenging as traditional data collection methods have limitations. We propose an alternative approach using social media. Methods We used natural language processing and machine learning to extract mentions of discontinuation of statin therapy from an online health forum, WebMD (http://www.webmd.com). We then extracted data according to themes and identified key attributes of the people posting for themselves. Results We identified 2121 statin reviews that contained information on discontinuing at least one named statin. Sixty percent of people posting declared themselves as female and the most common age category was 55–64 years. Over half the people taking statins did so for < 6 months. By far the most common reason given (90%) was patient experience of adverse events, the most common of which were musculoskeletal and connective tissue disorders. The rank order of adverse events reported in WebMD was largely consistent with those reported to regulatory agencies in the US and UK. Data were available on age, sex, duration of statin use, and, in some instances, adverse event resolution and rechallenge. In some instances, details were presented on resolution of the adverse event and rechallenge. Conclusion Social media may provide data on the reasons for switching or discontinuation of a medication, as well as unique patient perspectives that may influence continuation of a medication. This information source may provide unique data for novel interventions to reduce medication discontinuation. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01212-0.
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Smetana GW, Benson MD, Juraschek SP, Burns RB. Would You Recommend a Statin to This Patient for Primary Prevention of Cardiovascular Disease? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2022; 175:862-872. [PMID: 35696686 PMCID: PMC10096340 DOI: 10.7326/m22-0908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the United States. Hypercholesterolemia is a principal modifiable risk factor for the primary prevention of CVD. In addition to lifestyle modification, statins are an important tool to reduce risk for CVD in selected patients. A useful strategy to identify candidates for statins is to estimate the 10-year risk for CVD through the use of a validated risk calculator. Commonly used calculators include the Framingham risk score and the pooled cohort equation. Multiple randomized controlled trials have shown that statins reduce the risk for CVD in patients without known CVD. Two recent guidelines have proposed an approach to the use of statins in primary prevention of CVD. The American College of Cardiology/American Heart Association and the U.S. Department of Veterans Affairs guidelines form the basis for this discussion. The guidelines differ on the use of advanced testing to modify the 10-year CVD risk estimate and on the need for low-density lipoprotein cholesterol targets to establish the efficacy of statins. Advanced testing with coronary artery calcium measurement may be helpful for patients who are potentially eligible for statin therapy but who are uncertain if they wish to take a statin. In this paper, 2 experts, a preventive cardiologist and a general internist, discuss their approach to the use of statins for primary prevention of CVD and how they would apply the guidelines to an individual patient.
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Affiliation(s)
- Gerald W Smetana
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.W.S., M.D.B., S.P.J., R.B.B.)
| | - Mark D Benson
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.W.S., M.D.B., S.P.J., R.B.B.)
| | - Stephen P Juraschek
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.W.S., M.D.B., S.P.J., R.B.B.)
| | - Risa B Burns
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.W.S., M.D.B., S.P.J., R.B.B.)
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13
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Ferhatbegović L, Mršić D, Kušljugić S, Pojskić B. LDL-C: The Only Causal Risk Factor for ASCVD. Why Is It Still Overlooked and Underestimated? Curr Atheroscler Rep 2022; 24:635-642. [PMID: 35635632 DOI: 10.1007/s11883-022-01037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Low-density lipoprotein cholesterol (LDL-C) is the most important causal risk factor for atherosclerotic cardiovascular disease (ASCVD). This article reviews why LDL-C remains overlooked and underestimated despite numerous studies that have proved its role. RECENT FINDINGS Recently published EAS/ESC Guidelines for dyslipidemia and EAS Guidelines for prevention set new targets for LDL-C levels in primary and secondary prevention of ASCVD. These guidelines are based on data from large studies and meta-analyzes that have shown that lower LDL-C also means lower cardiovascular event rates. Real-life experience published in registries worldwide has shown us that the guidelines have not been translated to everyday clinical practice, meaning that a significant number of patients are undertreated and have LDL-C levels well above target. Potential reasons for the abovementioned are poor adherence and education of the patient and physician and health care system related factors. Implementation of the latest version of guidelines will require continuous patient and physicians education, as well as a shared decision-making process between physician and patient.
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Affiliation(s)
- Lamija Ferhatbegović
- Department for Internal Diseases and Hemodialysis, Cantonal Hospital Zenica, 72 000, Zenica, Bosnia and Herzegovina.
| | - Denis Mršić
- Clinic for Internal Disease, University Clinical Center Tuzla, 75 000, Tuzla, Bosnia and Herzegovina
| | - Sabina Kušljugić
- Medical Faculty Tuzla, University Clinical Center Tuzla, 75 000, Tuzla, Bosnia and Herzegovina
| | - Belma Pojskić
- Department for Internal Diseases and Hemodialysis, Cantonal Hospital Zenica, 72 000, Zenica, Bosnia and Herzegovina
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14
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Chow CK, Klimis H, Thiagalingam A, Redfern J, Hillis GS, Brieger D, Atherton J, Bhindi R, Chew DP, Collins N, Andrew Fitzpatrick M, Juergens C, Kangaharan N, Maiorana A, McGrady M, Poulter R, Shetty P, Waites J, Hamilton Craig C, Thompson P, Stepien S, Von Huben A, Rodgers A. Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome: The TEXTMEDS Randomized Clinical Trial. Circulation 2022; 145:1443-1455. [PMID: 35533220 DOI: 10.1161/circulationaha.121.056161] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND TEXTMEDS (Text Messages to Improve Medication Adherence and Secondary Prevention After Acute Coronary Syndrome) examined the effects of text message-delivered cardiac education and support on medication adherence after an acute coronary syndrome. METHODS TEXTMEDS was a single-blind, multicenter, randomized controlled trial of patients after acute coronary syndrome. The control group received usual care (secondary prevention as determined by the treating clinician); the intervention group also received multiple motivational and supportive weekly text messages on medications and healthy lifestyle with the opportunity for 2-way communication (text or telephone). The primary end point of self-reported medication adherence was the percentage of patients who were adherent, defined as >80% adherence to each of up to 5 indicated cardioprotective medications, at both 6 and 12 months. RESULTS A total of 1424 patients (mean age, 58 years [SD, 11]; 79% male) were randomized from 18 Australian public teaching hospitals. There was no significant difference in the primary end point of self-reported medication adherence between the intervention and control groups (relative risk, 0.93 [95% CI, 0.84-1.03]; P=0.15). There was no difference between intervention and control groups at 12 months in adherence to individual medications (aspirin, 96% vs 96%; β-blocker, 84% vs 84%; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 77% vs 80%; statin, 95% vs 95%; second antiplatelet, 84% vs 84% [all P>0.05]), systolic blood pressure (130 vs 129 mm Hg; P=0.26), low-density lipoprotein cholesterol (2.0 vs 1.9 mmol/L; P=0.34), smoking (P=0.59), or exercising regularly (71% vs 68%; P=0.52). There were small differences in lifestyle risk factors in favor of intervention on body mass index <25 kg/m2 (21% vs 18%; P=0.01), eating ≥5 servings per day of vegetables (9% vs 5%; P=0.03), and eating ≥2 servings per day of fruit (44% vs 39%; P=0.01). CONCLUSIONS A text message-based program had no effect on medical adherence but small effects on lifestyle risk factors. REGISTRATION URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364448; Unique identifier: ANZCTR ACTRN12613000793718.
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Affiliation(s)
- Clara K Chow
- Westmead Applied Research Institute (C.K.C., H.K., A.T., A.V.H., A.R.), University of Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia (C.K.C., H.K., A.T.)
| | - Harry Klimis
- Westmead Applied Research Institute (C.K.C., H.K., A.T., A.V.H., A.R.), University of Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia (C.K.C., H.K., A.T.)
| | - Aravinda Thiagalingam
- Westmead Applied Research Institute (C.K.C., H.K., A.T., A.V.H., A.R.), University of Sydney, Australia.,Department of Cardiology, Westmead Hospital, Sydney, Australia (C.K.C., H.K., A.T.)
| | - Julie Redfern
- Faculty of Medicine and Health (J.R., R.B., M.A.F., M.M.), University of Sydney, Australia
| | - Graham S Hillis
- University of Western Australia, Perth (G.S.H., P.T.).,Department of Cardiology, Royal Perth Hospital, Australia (G.S.H.)
| | - David Brieger
- ANZAC Research Institute (D.B.), University of Sydney, Australia
| | - John Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Australia (J.A.).,The University of Queensland, Brisbane, Australia (J.A., C.H.C.)
| | - Ravinay Bhindi
- Faculty of Medicine and Health (J.R., R.B., M.A.F., M.M.), University of Sydney, Australia.,Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (R.B.)
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia (D.P.C., N.K.)
| | | | | | - Craig Juergens
- Faculty of Medicine, The University of New South Wales, Sydney, Australia (C.J.).,Department of Cardiology, Liverpool Hospital, Sydney, Australia (C.J.)
| | - Nadarajah Kangaharan
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia (D.P.C., N.K.).,Department of Cardiology, Royal Darwin Hospital, Darwin, Australia (N.K.).,Menzies School of Health Research, Darwin, Australia (N.K.)
| | - Andrew Maiorana
- Allied Health Department, Fiona Stanley Hospital, Perth, Australia (A.M.).,School of Allied Health, Curtin University, Perth, Australia (A.M.)
| | - Michele McGrady
- Faculty of Medicine and Health (J.R., R.B., M.A.F., M.M.), University of Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (M.M.)
| | - Rohan Poulter
- Department of Cardiology, Sunshine Coast University Hospital, Brisbane, Australia (R.P.)
| | - Pratap Shetty
- Department of Cardiology, Wollongong and Shellharbour Hospitals, Wollongong, Australia (P.S.)
| | | | - Christian Hamilton Craig
- The University of Queensland, Brisbane, Australia (J.A., C.H.C.).,Department of Cardiology, Prince Charles Hospital, Brisbane, Australia (C.H.C.)
| | - Peter Thompson
- University of Western Australia, Perth (G.S.H., P.T.).,Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia (P.T.).,Harry Perkins Institute of Medical Research, Perth, Australia (P.T.)
| | - Sandrine Stepien
- The George Institute for Global Health, Sydney, Australia (C.K.C., H.K., A.R., G.S.H., S.S., A.R.)
| | - Amy Von Huben
- Westmead Applied Research Institute (C.K.C., H.K., A.T., A.V.H., A.R.), University of Sydney, Australia
| | - Anthony Rodgers
- Westmead Applied Research Institute (C.K.C., H.K., A.T., A.V.H., A.R.), University of Sydney, Australia
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15
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Rasul FB, Sarker M, Yasmin F, De Allegri M. Exploring health-seeking behavior for non-communicable chronic conditions in northern Bangladesh. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000497. [PMID: 36962348 PMCID: PMC10022368 DOI: 10.1371/journal.pgph.0000497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
Abstract
Non-communicable Diseases (NCDs) account for 67% of total deaths in Bangladesh. However, the Bangladeshi health system is inadequately prepared to tackle NCDs. Evidence on NCD-specific health-seeking behavior can help appropriately address the needs of people affected by NCDs in Bangladesh. Our study aims to explore health-seeking behavior for people affected by NCDs in northern Bangladesh. We conducted a qualitative study in Mithapukur, Rangpur, during 2015-2016. We purposely selected respondents and carried out 25 in-depth interviews with individuals affected by non-communicable diseases and 21 healthcare providers. Additionally, we held six focus group discussions in the wider community. We verbatim transcribed all interviews and analyzed the content using thematic analysis, according to the following thematic areas: individual, household, and contextual factors that influence health-seeking behavior for NCDs within the context of the broader socio-economic environment. Study findings indicate that people seek care only when symptoms disrupt their daily lifestyle. Henceforth, people's health beliefs, religious beliefs, and relations with local providers direct their actions, keeping provider accessibility, cost anticipation, and satisfying provider-encounters in mind. Health-seeking is predominantly delayed and fragmented. Semi-qualified providers represent a popular first choice. Gender roles dominate health-seeking behavior as women need their guardian's permission to avail care. Our findings indicate the need to sensitize people about the importance of early health-seeking for NCDs, and continuing life-long NCD treatment. Our findings also highlight the need for people-centered care, making preventive and curative NCD services accessible at grassroots level, along with relevant provider training. Furthermore, special provisions, such as financial support and outreach programs are needed to enable access to NCD care for women and the poor.
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Affiliation(s)
- Fatema Binte Rasul
- Medical Faculty and University Hospital, Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- BRAC JPG School of Public Health, BRAC University, Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, Bangladesh
| | - Malabika Sarker
- Medical Faculty and University Hospital, Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
- BRAC JPG School of Public Health, BRAC University, Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, Bangladesh
| | - Farzana Yasmin
- Faculty of Health, Department of Human Medicine, University Witten/Herdecke, Witten, Germany
| | - Manuela De Allegri
- Medical Faculty and University Hospital, Heidelberg Institute of Global Health, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
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16
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Castillo AF, Davis AL, Fischhoff B, Krishnamurti T. Digital medicines for adherence support: A conceptual framework and qualitative study of adherence among chronically ill patients. Health Informatics J 2021; 27:14604582211059463. [PMID: 34825829 DOI: 10.1177/14604582211059463] [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: 11/16/2022]
Abstract
Digital medicine programs (DMPs) are emerging technologies that use sensor-enabled medicine to detect when patients have taken their medication and then provide feedback about adherence. We use qualitative methods to understand how patients change their behavioral patterns while participating in a DMP intervention. An influence diagram outlining the factors hypothesized to affect adherence in DMPs constructed from prior scientific research and expert input was created. Subsequently, we conducted semi-structured interviews with 10 patients to see if their experience supported the relationships outlined in the model. We identified three pathways by which DMPs are likely to change behavior around medication adherence: (1) providing patients and providers with accurate, personalized information about adherence; (2) improving patient-provider interactions by structuring them around this information; and (3) facilitating routines and habits for medication use. Chronically ill patients often fail to adhere to drug regimens. Patients in a DMP intervention used the DMP-provided information to better understand drug efficacy and collaborated with their physician to develop adherence strategies. DMPs can promote medication adherence among patients who are willing to use them and may be most effective if physicians are active partners in the DMP.
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Affiliation(s)
| | - Alexander L Davis
- Department of Engineering and Public Policy, 6612Carnegie Mellon University, Pittsburgh, PA, USA
| | - Baruch Fischhoff
- Department of Engineering and Public Policy, 6612Carnegie Mellon University, Pittsburgh, PA, USA
| | - Tamar Krishnamurti
- Division of General Internal Medicine, 6614University of Pittsburgh, Pittsburgh, PA, USA
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17
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Factors related to self-care drug treatment and medication adherence of elderly people in Japan. PUBLIC HEALTH IN PRACTICE 2021; 2:100106. [PMID: 36101625 PMCID: PMC9461522 DOI: 10.1016/j.puhip.2021.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives Study design Methods Results Conclusions Medication adherence was significantly positively associated with health literacy. Good communication with doctors was closely related to medication adherence. Promoting health literacy and communication when supporting self-care drug treatment for elderly people.
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18
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Daly CME, Loi L, Booth J, Saidan D, Guerrero K, Tyagi V. Self-management of overactive bladder at home using transcutaneous tibial nerve stimulation: a qualitative study of women's experiences. BMC WOMENS HEALTH 2021; 21:374. [PMID: 34706709 PMCID: PMC8555155 DOI: 10.1186/s12905-021-01522-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022]
Abstract
Background Transcutaneous tibial nerve stimulation (TTNS) has been used to treat overactive bladder (OAB), however patient experiences and views of this treatment are lacking. The aim of this study was to explore women’s experiences of OAB and TTNS treatment and the perceived factors influencing participation and adherence. Methods Semi-structured, individual interviews conducted as part of a mixed-methods, randomised, feasibility trial of self-managed versus HCP-led TTNS. Interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis was undertaken using Booth et al. (Neurourol Urodynam. 2017;37:528–41) approach. Results 16 women were interviewed, 8 self-managing TTNS at home and 8 receiving TTNS in twice-weekly hospital clinic appointments. Women self-managing OAB considered TTNS easy to administer, flexible and favourably ‘convenient’, especially when the participant was bound by work and other life commitments. In contrast to OAB symptoms ‘dominating life’, self-managing bladder treatment was empowering and fitted around home life demands. Flexibility and control engendered by self-management, facilitated women’s willingness to participate in TTNS. Women attending a hospital clinic for TTNS enjoyed the social aspects but found the routine appointments constrained their lives. Motivation to continue TTNS in the longer term was dependent on perception of benefit. Conclusions This study provides novel insights into women’s experiences of self-managing their OAB using TTNS compared to HCP-led management in the clinical setting. It highlights positive experiences self-managing TTNS at home and a willingness to continue in the longer term, facilitated by ease of use and convenience. Trial Registration 1/11/2018: ClinicalTrials.gov Identifier: NCT03727711.
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Affiliation(s)
- Ciara M E Daly
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK.
| | - Lynette Loi
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Jo Booth
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Dalia Saidan
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Karen Guerrero
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - Veenu Tyagi
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
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19
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Majd Z, Mohan A, Abughosh SM. Using group-based trajectory modeling to characterize the association of past ACEIs/ARBs adherence with subsequent statin adherence patterns among new statin users. J Am Pharm Assoc (2003) 2021; 61:829-837.e2. [PMID: 34344613 DOI: 10.1016/j.japh.2021.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/21/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite well-documented benefits, statin adherence remains suboptimal. Studies have suggested that previous adherence to other chronic medications is a strong predictor of future adherence to newly initiated statins. Group-based trajectory modeling (GBTM) has been applied as a method to longitudinally depict the dynamic nature of adherence. OBJECTIVES This study aimed to examine the association between patients' adherence patterns to newly initiated statins and previous adherence trajectories of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) using GBTM. METHODS This retrospective cohort study was conducted among continuously enrolled statin initiators using claims data. Patients were included if they had ACEI/ARB use within 1 year before statin initiation (preindex period). Monthly adherence to ACEIs/ARBs was calculated during the preindex period and monthly adherence to statins was assessed 1 year after statin initiation using proportion of days covered (PDC). The monthly PDCs were modeled as a longitudinal response in a logistic GBTM to provide distinct patterns of adherence for ACEIs/ARBs and statins, separately. A multinomial logistic regression was conducted to determine an association between ACEI/ARB adherence trajectories and future statin trajectories, controlling for patient characteristics. RESULTS A total of 1078 patients were categorized into 4 distinct statin adherence trajectories: adherent (40.8%), gradual decline (37.4%), gaps in adherence (13.9%), and rapid decline (7.9%). Patients were further categorized into 4 groups on the basis of their distinct past ACEIs/ARBs trajectories: adherent (43%), gaps in adherence (29%), delayed nonadherence (15.2%), and gradual decline (12.8%). In the multinomial logistic regression, patients in the gaps in adherence or gradual decline groups were more likely to follow similar trajectories for future statin use than the adherent trajectory. CONCLUSION Previous adherence trajectories of ACEIs/ARBs may predict future adherence patterns for newly initiated statins. Knowledge of past medication-taking behavior could provide valuable information for developing tailored interventions to improve adherence.
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20
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Yerrapragada G, Siadimas A, Babaeian A, Sharma V, O'Neill TJ. Machine Learning to Predict Tamoxifen Nonadherence Among US Commercially Insured Patients With Metastatic Breast Cancer. JCO Clin Cancer Inform 2021; 5:814-825. [PMID: 34383580 DOI: 10.1200/cci.20.00102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Adherence to tamoxifen citrate among women diagnosed with metastatic breast cancer can improve survival and minimize recurrence. This study aimed to use real-world data and machine learning (ML) methods to classify tamoxifen nonadherence. METHODS A cohort of women diagnosed with metastatic breast cancer from 2012 to 2017 were identified from IBM MarketScan Commercial Claims and Encounters and Medicare claims databases. Patients with < 80% proportion of days coverage in the year following treatment initiation were classified as nonadherent. Training and internal validation cohorts were randomly generated (4:1 ratio). Clinical procedures, comorbidity, treatment, and health care encounter features in the year before tamoxifen initiation were used to train logistic regression, boosted logistic regression, random forest, and feedforward neural network models and were internally validated on the basis of area under receiver operating characteristic curve. The most predictive ML approach was evaluated to assess feature importance. RESULTS A total of 3,022 patients were included with 40% classified as nonadherent. All models had moderate predictive accuracy. Logistic regression (area under receiver operating characteristic 0.64) was interpreted with 94% sensitivity (95% CI, 89 to 92) and 0.31 specificity (95% CI, 29 to 33). The model accurately classified adherence (negative predictive value 89%) but was nondiscriminate for nonadherence (positive predictive value 48%). Variable importance identified top predictive factors, including age ≥ 55 years and pretreatment procedures (lymphatic nuclear medicine, radiation oncology, and arterial surgery). CONCLUSION ML using baseline administrative data predicts tamoxifen nonadherence. Screening at treatment initiation may support personalized care, improve health outcomes, and minimize cost. Baseline claims may not be sufficient to discriminate adherence. Further validation with enriched longitudinal data may improve model performance.
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Affiliation(s)
- Gayathri Yerrapragada
- School of Computing, Clemson University, Clemson, SC.,Data Science & Services, Diagnostics Information Solutions, Roche Diagnostics, Belmont, CA
| | - Athanasios Siadimas
- Data Science & Services, Diagnostics Information Solutions, Roche Diagnostics, Belmont, CA
| | - Amir Babaeian
- Data Science & Services, Diagnostics Information Solutions, Roche Diagnostics, Belmont, CA
| | - Vishakha Sharma
- Data Science & Services, Diagnostics Information Solutions, Roche Diagnostics, Belmont, CA
| | - Tyler J O'Neill
- Data Science & Services, Diagnostics Information Solutions, Roche Diagnostics, Belmont, CA
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21
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The effect of statin therapy on disease-related outcomes in idiopathic pulmonary fibrosis: A systematic review and meta-analysis. Respir Med Res 2021; 80:100792. [PMID: 34091200 DOI: 10.1016/j.resmer.2020.100792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis is a progressive disease and antifibrotic therapies do not reverse existing fibrosis. There has been emerging evidence of potential role for statins in idiopathic pulmonary fibrosis. The aim of this review is to synthesise the evidence on the efficacy of statins in idiopathic pulmonary fibrosis, focusing on associations with all-cause mortality, disease-specific mortality and change in pulmonary function. METHODS Medline and Embase were reviewed to identify relevant publications. Studies were selected if they examined disease-related outcomes including mortality, pulmonary function and adverse events in people with idiopathic pulmonary fibrosis receiving statin therapy. RESULTS Five studies with a total of 3407 people with IPF were selected and analysed. The overall risk of bias of five included studies was moderate to serious. In the fixed effect meta-analysis, statin use was associated with a reduction in mortality (RR 0.8; 95% CI 0.72-0.99). However, in the random effects model, there was no longer any significant association between statin use and all-cause mortality (RR 0.87; 95% CI 0.68-1.12). There was no statistically significant association between statin use and decline in FVC % predicted. CONCLUSION There is currently insufficient evidence to conclude the effect of statin therapy on disease-related outcomes in idiopathic pulmonary fibrosis. Considering the limitations of available literature, we would recommend a prospective cohort study with capture of dosage and preparation of statin, statin adherence and use of concurrent antifibrotic treatment. PROSPERO REGISTRATION NUMBER CRD42019122745.
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22
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Klimis H, Chow CK. Are Digital Health Services the Key to Bridging the Gap in Medication Adherence and Optimisation? Heart Lung Circ 2021; 30:943-946. [PMID: 33965305 DOI: 10.1016/j.hlc.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Harry Klimis
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology Westmead Hospital, Sydney, NSW, Australia.
| | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia; Department of Cardiology Westmead Hospital, Sydney, NSW, Australia
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23
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Discovery of an orally active VHL-recruiting PROTAC that achieves robust HMGCR degradation and potent hypolipidemic activity in vivo. Acta Pharm Sin B 2021; 11:1300-1314. [PMID: 34094835 PMCID: PMC8148065 DOI: 10.1016/j.apsb.2020.11.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 12/13/2022] Open
Abstract
HMG-CoA reductase (HMGCR) protein is usually upregulated after statin (HMGCR inhibitor) treatment, which inevitably diminishes its therapeutic efficacy, provoking the need for higher doses associated with adverse effects. The proteolysis targeting chimera (PROTAC) technology has recently emerged as a powerful approach for inducing protein degradation. Nonetheless, due to their bifunctional nature, developing orally bioavailable PROTACs remains a great challenge. Herein, we identified a powerful HMGCR-targeted PROTAC (21c) comprising a VHL ligand conjugated to lovastatin acid that potently degrades HMGCR in Insig-silenced HepG2 cells (DC50 = 120 nmol/L) and forms a stable ternary complex, as predicated by a holistic modeling protocol. Most importantly, oral administration of the corresponding lactone 21b reveled favorable plasma exposures referring to both the parent 21b and the conversed acid 21c. Further in vivo studies of 21b demonstrated robust HMGCR degradation and potent cholesterol reduction in mice with diet-induced hypercholesterolemia, highlighting a promising strategy for treating hyperlipidemia and associated diseases.
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Key Words
- CRBN, cereblon
- CVD, cardiovascular disease
- Cholesterol reduction
- DC50, half degradation concentration
- ER, endoplasmic reticulum
- H&E, hematoxylin/eosin
- HDAC, histone deacetylase
- HMGCR
- HMGCR, 3-hydroxy-3-methylglutaryl coenzyme A reductase
- LDL-C, low-density lipoprotein cholesterol
- MFD, medium fat diet
- ORO, oil-red O
- Oral bioavailability
- PK, pharmacokinetic
- PROTAC, proteolysis-targeting chimera
- PROTACs
- SAR, structure–activity relationship
- TC, total cholesterol
- TG, triglyceride
- VHL, von Hippel-Lindau
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Ryou IS, Chang J, Son JS, Ko A, Choi S, Kim K, Kim SM, Park SM. Association between CVDs and initiation and adherence to statin treatment in patients with newly diagnosed hypercholesterolaemia: a retrospective cohort study. BMJ Open 2021; 11:e045375. [PMID: 33827840 PMCID: PMC8031030 DOI: 10.1136/bmjopen-2020-045375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To evaluate the association between incident cardiovascular disease (CVD) and initiation and adherence to statin treatment for primary prevention of CVD in patients with newly diagnosed hypercholesterolaemia. DESIGN A population-based retrospective cohort study. SETTING This study used National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) from Republic of Korea. PARTICIPANTS This study included 11 320 participants without previous history of CVD aged between 40 and 79 years who had elevated total cholesterol level (more than 240 mg/dL) and had initiated statin treatment within 24 months of the national health screening from 2004 to 2012 identified in the NHIS-HEALS. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome, CVD, was defined as first-ever admission or death due to ischaemic heart disease, acute myocardial infarction, revascularisation or stroke, or December 31 2013. The HRs of CVD according to statin adherence were calculated according to stratification by Systematic COronary Risk Evaluation. RESULTS Early statin initiation significantly lowered risk of CVD outcomes compared with late initiation (HR of late statin user, 1.24; 95% CI 1.02 to 2.51). Among early initiators, statin discontinuers had a significantly higher risk for CVD compared with persistent users (HR, 1.71; 95% CI 1.10 to 2.67), while statin reinitiators had an attenuated risk increase (HR 1.34, 95% CI 0.79 to 2.30). CONCLUSIONS Among statin users with newly diagnosed hypercholesterolaemia, early statin initiation is associated with lower CVD risk compared with late initiation. Furthermore, statin discontinuation is associated with increased risk of CVD, but reinitiation attenuated the risk.
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Affiliation(s)
- In Sun Ryou
- Family Medicine, Ewha Womans University School of Medicine, Seoul, Korea (the Republic of)
| | - Jooyoung Chang
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Joung Sik Son
- Family Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Ahryoung Ko
- Family Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Kyuwoong Kim
- Division of Cancer Control and Policy; National Cancer Survivorship Center, National Cancer Control Institute, National Cancer Center, Gyeonggi-do, Korea (the Republic of)
| | - Sung Min Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)
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Lee WK, Lee J. Evaluation and improvement of adherence to medication. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.2.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Medication adherence refers to the extent to which a patient takes medication according to prescription. In many cases, adherence to medication is defined as the proportion of prescribed drugs taken as prescribed over a certain period. However, there is no satisfactory level of adherence that can be applied uniformly to all diseases and medications. Patients with poor adherence experience worsening of conditions, complications, and increased risk for death, which increases medical expenses. Therefore, to improve medication adherence, healthcare providers should try to identify poor adherence, adjust prescriptions to optimize treatment according to the patient’s lifestyle, and educate patients to help them understand the value of medical treatment and the effects of adherence. The most practical way to identify poor adherence during clinical visits is by asking patients about their medication adherence in a non-judgmental manner. Reducing the number of doses is more effective than reducing the number of tablets to increase compliance. It is necessary to adopt innovative methods based on information technology in our healthcare system because of the labor-intensive nature of educational intervention to improve adherence.
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Kim JB, Song WH, Park JS, Youn TJ, Park YH, Kim SJ, Ahn SG, Doh JH, Cho YH, Kim JW. A randomized, open-label, parallel, multi-center Phase IV study to compare the efficacy and safety of atorvastatin 10 and 20 mg in high-risk Asian patients with hypercholesterolemia. PLoS One 2021; 16:e0245481. [PMID: 33481866 PMCID: PMC7822387 DOI: 10.1371/journal.pone.0245481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Although accumulating evidence suggests a more extensive reduction of low-density lipoprotein cholesterol (LDL-C), it is unclear whether a higher statin dose is more effective and cost-effective in the Asian population. This study compared the efficacy, safety, and cost-effectiveness of atorvastatin 20 and 10 mg in high-risk Asian patients with hypercholesterolemia. Methods A 12-week, open-label, parallel, multicenter, Phase IV randomized controlled trial was conducted at ten hospitals in the Republic of Korea between October 2017 and May 2019. High-risk patients with hypercholesterolemia, defined according to 2015 Korean guidelines for dyslipidemia management, were eligible to participate. We randomly assigned 250 patients at risk of atherosclerotic cardiovascular disease to receive 20 mg (n = 124) or 10 mg (n = 126) of atorvastatin. The primary endpoint was the difference in the mean percentage change in LDL-C levels from baseline after 12 weeks. Cost-effectiveness was measured as an exploratory endpoint. Results LDL-C levels were reduced more significantly by atorvastatin 20 mg than by 10 mg after 12 weeks (42.4% vs. 33.5%, p < 0.0001). Significantly more patients achieved target LDL-C levels (<100 mg/dL for high-risk patients, <70 mg/dL for very high-risk patients) with atorvastatin 20 mg than with 10 mg (40.3% vs. 25.6%, p < 0.05). Apolipoprotein B decreased significantly with atorvastatin 20mg versus 10 mg (−36.2% vs. −29.9%, p < 0.05). Lipid ratios also showed greater improvement with atorvastatin 20 mg than with 10 mg (total cholesterol/high-density lipoprotein cholesterol ratio, −33.3% vs. −29.4%, p < 0.05; apolipoprotein B/apolipoprotein A1 ratio, −36.7% vs. −31.4%, p < 0.05). Atorvastatin 20 mg was more cost-effective than atorvastatin 10 mg in terms of both the average and incremental cost-effectiveness ratios. Safety and tolerability of atorvastatin 20 mg were comparable to those of atorvastatin 10 mg. Conclusion In high-risk Asian patients with hypercholesterolemia, atorvastatin 20 mg was both efficacious in reducing LDL-C and cost-effective compared with atorvastatin 10 mg.
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Affiliation(s)
- Ji Bak Kim
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Woo Hyuk Song
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jong Sung Park
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong Hyun Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Shin-Jae Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung Gyun Ahn
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Joon-Hyung Doh
- Department of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yun-Hyeong Cho
- Department of Internal Medicine, Myongji Hospital, Goyang, Korea
| | - Jin Won Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
- * E-mail:
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Sigglekow F, Horsburgh S, Parkin L. Statin adherence is lower in primary than secondary prevention: A national follow-up study of new users. PLoS One 2020; 15:e0242424. [PMID: 33211724 PMCID: PMC7676659 DOI: 10.1371/journal.pone.0242424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/02/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Maintaining adherence to statins reduces the risk of an initial cardiovascular disease (CVD) event in high-risk individuals (primary prevention) and additional CVD events following the first event (secondary prevention). The effectiveness of statin therapy is limited by the level of adherence maintained by the patient. We undertook a nationwide study to compare adherence and discontinuation in primary and secondary prevention patients. METHODS Dispensing data from New Zealand community pharmacies were used to identify patients who received their first statin dispensing between 2006 and 2011. The Medication Possession Ratio (MPR) and proportion who discontinued statin medication was calculated for the year following first statin dispensing for patients with a minimum of two dispensings. Adherence was defined as an MPR ≥ 0.8. Previous CVD was identified using hospital discharge records. Multivariable logistic regression was used to control for demographic and statin characteristics. RESULTS Between 2006 and 2011 289,666 new statin users were identified with 238,855 (82.5%) receiving the statin for primary prevention compared to 50,811 (17.5%) who received it for secondary prevention. The secondary prevention group was 1.55 (95% CI 1.51-1.59) times as likely to be adherent and 0.67 (95% CI 0.65-0.69) times as likely to discontinue statin treatment than the primary prevention group. An early gap in statin coverage increased the odds of discontinuing statin treatment. CONCLUSION Adherence to statin medication is higher in secondary prevention than primary prevention. Within each group, a range of demographic and treatment factors further influences adherence.
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Affiliation(s)
- Finn Sigglekow
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
- * E-mail:
| | - Lianne Parkin
- Department of Preventive and Social Medicine, Otago Medical School—Dunedin Campus, University of Otago, Dunedin, New Zealand
- Pharmacoepidemiology Research Network, University of Otago, Dunedin, New Zealand
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Reston JT, Buelt A, Donahue MP, Neubauer B, Vagichev E, McShea K. Interventions to Improve Statin Tolerance and Adherence in Patients at Risk for Cardiovascular Disease : A Systematic Review for the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Management of Dyslipidemia. Ann Intern Med 2020; 173:806-812. [PMID: 32956601 DOI: 10.7326/m20-4680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Strategies to improve patients' tolerance of and adherence to statins may enhance the effectiveness of dyslipidemia treatment in those at risk for cardiovascular disease (CVD). PURPOSE To assess the benefits and harms of interventions to improve statin adherence in patients at risk for CVD. DATA SOURCES MEDLINE, EMBASE, PubMed, and the Cochrane Library from December 2013 through May 2019 (English language only). STUDY SELECTION Systematic reviews (SRs), randomized controlled trials (RCTs), and cohort studies that addressed interventions for improving statin tolerance and adherence. DATA EXTRACTION One investigator abstracted data and assessed study quality, and a second investigator checked abstractions and assessments for accuracy. DATA SYNTHESIS One SR, 1 RCT, and 4 cohort studies were included. The SR found that intensified patient care improved adherence and decreased levels of total serum cholesterol and low-density lipoprotein cholesterol (LDL-C) at 6 months or more of follow-up. Compared with statin treatment discontinuation, nondaily statin dosing lowered total cholesterol and LDL-C levels. One large cohort study suggested that more than 90% of patients who discontinued statin treatment could be rechallenged with the same or a different statin and be adherent 1 year after a statin-related adverse event led to discontinuation. Two small cohort studies reported that more than 90% of patients who were previously intolerant to statins and who had low baseline levels of vitamin D were able to adhere to statins 1 year after vitamin D supplementation. LIMITATION This is a qualitative synthesis of new evidence with existing meta-analyses, and studies had several methodological shortcomings. CONCLUSION Although the strength of evidence for most interventions was low or very low, intensified patient care and rechallenge with the same or a different statin (or a lower dose) seem to be favorable options for improving statin adherence. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs.
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Affiliation(s)
- James T Reston
- ECRI, Center for Clinical Evidence and Guidelines, Plymouth Meeting, Pennsylvania (J.T.R.)
| | - Andrew Buelt
- Bay Pines VA Healthcare System, Bay Pines, Florida (A.B.)
| | - Mark P Donahue
- Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina (M.P.D.)
| | - Brian Neubauer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (B.N.)
| | - Elena Vagichev
- Walter Reed National Military Medical Center, Bethesda, Maryland (E.V.)
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Berkovic MC, Bilic-Curcic I, Bozek T, Mahecic DH, Majanovic SK, Canecki-Varzic S, Andric J, Marusic S, Mrzljak A. Glucagon-like-1 receptor agonists and sodium/glucose cotransporter-2 inhibitors combination—are we exploiting their full potential in a real life setting? World J Diabetes 2020; 11:540-552. [PMID: 33269065 PMCID: PMC7672794 DOI: 10.4239/wjd.v11.i11.540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/29/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The sodium/glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like-1 receptor agonists (GLP-1RA) are antidiabetic agents effective both in hemoglobin A1c (HbA1c) reduction (with a low risk of hypoglycemia) and cardiovascular event prevention. In patients with type 2 diabetes, the add-on value of combination therapy of GLP-1RA and an SGLT-2i seems promising.
AIM To investigate whether the efficacy of GLP-1RA and SGLT-2i combination observed in randomized controlled trials translates into therapeutic benefits in the Croatian population during routine clinical practice and follow-up.
METHODS We included 200 type 2 diabetes patients with poor glycemic control and analyzed the effects of treatment intensification with (1) GLP-1RA on top of SGLT-2i, (2) SGLT-2i on top of GLP-1RA compared to (3) simultaneous addition of both agents. The primary study endpoint was the proportion of participants with HbA1c < 7.0% and/or 5% bodyweight reduction. Secondary outcomes included changes in fasting plasma glucose (FPG), prandial plasma glucose, low-density lipoprotein cholesterol, estimated glomerular filtration rate (eGFR), and cardiovascular (CV) incidents assessment over a follow-up period of 12 mo.
RESULTS The majority of patients were over 65-years-old, had diabetes duration for more than 10 years. The initial body mass index was 39.41 ± 5.49 kg/m2 and HbA1c 8.32 ± 1.26%. Around half of the patients in all three groups achieved target HbA1c below 7%. A more pronounced decrease in the HbA1c seen with simultaneous SGLT-2i and GLP-1RA therapy was a result of higher baseline HbA1c and not the effect of initiating combination therapy. The number of patients achieving FPG below 7.0 mmol/L was significantly higher in the SGLT-2i group (P = 0.021), and 5% weight loss was dominantly achieved in the simultaneous therapy group (P = 0.044). A composite outcome (reduction of HbA1c below 7% (53 mmol/mol) with 5% weight loss) was achieved in 32.3% of total patients included in the study. Only 18.2% of patients attained composite outcome defined as HbA1c below 7% (53 mmol/mol) with 5% weight loss and low-density lipoprotein cholesterol < 2.5 mmol/L. There were no significant differences between treatment groups. No differences were observed regarding CV incidents or eGFR according to treatment group over a follow-up period.
CONCLUSION Combination therapy with GLP-1RA and SGLT-2i is effective in terms of metabolic control, although it remains to be determined whether simultaneous or sequential intensification is better.
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Affiliation(s)
- Maja Cigrovski Berkovic
- Faculty of Medicine, J. J. Strossmayer University Osijek, Osijek 31000, Croatia
- Department for Endocrinology, Diabetes and Clinical Pharmacology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
- Department of Kinesiological Anthropology and Methodology, Faculty of Kinesiology, University of Zagreb, Zagreb 10000, Croatia
| | - Ines Bilic-Curcic
- Faculty of Medicine, J. J. Strossmayer University Osijek, Osijek 31000, Croatia
- Department of Endocrinology and Metabolism Disorders, Clinical Hospital Center, Osijek 31000, Croatia
| | - Tomislav Bozek
- University Clinic for Diabetes “Vuk Vrhovac”, Merkur University Hospital, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Davorka Herman Mahecic
- Department for Endocrinology, Diabetes and Metabolism, University Hospital Centre “Sestre milosrdnice”, Zagreb 10000, Croatia
| | - Sanja Klobucar Majanovic
- Department for Endocrinology, Diabetes and Metabolism, University Hospital Centre Rijeka, School of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Silvija Canecki-Varzic
- Faculty of Medicine, J. J. Strossmayer University Osijek, Osijek 31000, Croatia
- Department of Endocrinology and Metabolism Disorders, Clinical Hospital Center, Osijek 31000, Croatia
| | - Jelena Andric
- Department for Endocrinology, Diabetes and Clinical Pharmacology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
| | - Srecko Marusic
- Department for Endocrinology, Diabetes and Clinical Pharmacology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Medicine, Merkur University Hospital, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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Patient adherence to multivitamin supplementation after bariatric surgery: a narrative review. J Nutr Sci 2020; 9:e46. [PMID: 33101663 PMCID: PMC7550964 DOI: 10.1017/jns.2020.41] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023] Open
Abstract
Morbid obesity is a growing problem worldwide and has subsequently resulted in a wide application of bariatric surgery to achieve long-term weight loss and improvement of obesity-related co-morbidities. In spite of these clinical benefits, vitamin deficiencies are common after bariatric surgery; therefore, lifelong multivitamin supplementation (MVS) is recommended. However, patient adherence to MVS intake is generally poor. The aim of this narrative review is to analyse which factors influence the adherence of MVS intake after bariatric surgery. To provide an extensive overview, we will discuss the different factors that influence MVS use in patients who underwent bariatric surgery, but also review the literature on MVS in other patient groups.
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Kirsch M, Montgomery JR, Hu HM, Englesbe M, Hallstrom B, Brummett CM, Fendrick AM, Waljee JF. Association between insurance cost-sharing subsidy and postoperative opioid prescription refills among Medicare patients. Surgery 2020; 168:244-252. [PMID: 32505547 PMCID: PMC8489972 DOI: 10.1016/j.surg.2020.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/06/2020] [Accepted: 04/04/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Models of health care coverage with varying degrees of patient cost-sharing have been shown to influence health care behaviors for chronic conditions including medication adherence. The effect of insurance cost-sharing subsidies on the probability of postoperative opioid refill, however, is unclear. METHODS This retrospective cohort study examined 100% Medicare claims data among patients (N = 21,781) ages 65 and older undergoing orthopedic procedures in Michigan between January 2013 and September 2016. Patients were classified based on the presence of low-income subsidy and on prior opioid exposure using Medicare Part D prescription files of drug events. We investigated the association of these factors with the probability of both initial and second postoperative opioid fill within 90 days from the date of discharge. RESULTS In this cohort, 84.6% of patients filled an initial opioid prescription, and 66.4% refilled an opioid prescription. Patients with a full low-income subsidy had greater odds of refill within the postoperative 90 days compared with those patients without a low-income subsidy (odds ratio 1.38, 95% confidence interval 1.18-1.60). Among opioid naïve patients with a full low-income subsidy, the adjusted refill rate was 61.3% (95% confidence interval 58.0-64.7%) compared with 57.6% (95% confidence interval 51.4-63.7%) among those with partial low-income subsidy and 54.2% (95% confidence interval 52.8-55.6%) among patients without low-income subsidy. CONCLUSION Among Medicare patients undergoing orthopedic procedures, a full medication subsidy is associated with an increased probability of opioid refill when compared with no subsidy. Going forward, it is critical to lessen financial barriers to ensure all patients have equitable access to postoperative analgesia, including both opioid and nonopioid analgesics by decreasing the patient burden of cost-sharing.
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Affiliation(s)
| | - John R Montgomery
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Hsou Mei Hu
- Michigan Opioid Prescribing Engagement Network, Ann Arbor, MI
| | - Michael Englesbe
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Brian Hallstrom
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Chad M Brummett
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI
| | - A Mark Fendrick
- Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, MI
| | - Jennifer F Waljee
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
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Hu F, Warren J, Exeter DJ. Predicting Lipid-Lowering Medication Persistence after the First Cardiovascular Disease Hospitalization. Methods Inf Med 2020; 59:61-74. [DOI: 10.1055/s-0040-1713905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Abstract
Objectives This study analyzed patient factors in medication persistence after discharge from the first hospitalization for cardiovascular disease (CVD) with the aim of predicting persistence to lipid-lowering therapy for 1 to 2 years.
Methods A subcohort having a first CVD hospitalization was selected from 313,207 patients for proportional hazard model analysis. Logistic regression, support vector machine, artificial neural networks, and boosted regression tree (BRT) models were used to predict 1- and 2-year medication persistence.
Results Proportional hazard modeling found significant association of persistence with age, diabetes history, complication and comorbidity level, days stayed in hospital, CVD diagnosis type, in-patient procedures, and being new to therapy. BRT had the best predictive performance with c-statistic of 0.811 (0.799–0.824) for 1-year and 0.793 (0.772–0.814) for 2-year prediction using variables potentially available shortly after discharge.
Conclusion The results suggest that development of a machine learning-based clinical decision support tool to focus improvements in secondary prevention of CVD is feasible.
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Affiliation(s)
- Feiyu Hu
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Daniel J. Exeter
- School of Population Health, University of Auckland, Auckland, New Zealand
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Bradley CK, Wang TY, Li S, Robinson JG, Roger VL, Goldberg AC, Virani SS, Louie MJ, Lee LV, Peterson ED, Navar AM. Patient-Reported Reasons for Declining or Discontinuing Statin Therapy: Insights From the PALM Registry. J Am Heart Assoc 2020; 8:e011765. [PMID: 30913959 PMCID: PMC6509731 DOI: 10.1161/jaha.118.011765] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Many adults eligible for statin therapy for cardiovascular disease prevention are untreated. Our objective was to investigate patient‐reported reasons for statin underutilization, including noninitiation, refusal, and discontinuation. Methods and Results This study included the 5693 adults recommended for statin therapy in the PALM (Patient and Provider Assessment of Lipid Management) registry. Patient surveys evaluated statin experience, reasons for declining or discontinuing statins, and beliefs about statins and cardiovascular disease risk. Overall, 1511 of 5693 adults (26.5%) were not on treatment. Of those not on a statin, 894 (59.2%) reported never being offered a statin, 153 (10.1%) declined a statin, and 464 (30.7%) had discontinued therapy. Women (relative risk: 1.22), black adults (relative risk: 1.48), and those without insurance (relative risk: 1.38) were most likely to report never being offered a statin. Fear of side effects and perceived side effects were the most common reasons cited for declining or discontinuing a statin. Compared with statin users, those who declined or discontinued statins were less likely to believe statins are safe (70.4% of current users vs. 36.9% of those who declined and 37.4% of those who discontinued) or effective (86.3%, 67.4%, and 69.1%, respectively). Willingness to take a statin was high; 67.7% of those never offered and 59.7% of patients who discontinued a statin would consider initiating or retrying a statin. Conclusions More than half of patients eligible for statin therapy but not on treatment reported never being offered one by their doctor. Concern about side effects was the leading reason for statin refusal or discontinuation. Many patients were willing to reconsider statin therapy if offered. See Editorial by Braun
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Affiliation(s)
- Corey K Bradley
- 1 Department of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Tracy Y Wang
- 1 Department of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Shuang Li
- 1 Department of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Jennifer G Robinson
- 2 Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Veronique L Roger
- 3 Department of Internal Medicine Division of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Salim S Virani
- 5 Department of Medicine Baylor College of Medicine Houston TX
| | - Michael J Louie
- 6 Global Medical Affairs Regeneron Pharmaceuticals, Inc. Tarrytown NY
| | | | - Eric D Peterson
- 1 Department of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NC
| | - Ann Marie Navar
- 1 Department of Medicine and Duke Clinical Research Institute Duke University School of Medicine Durham NC
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Ezetimibe and Improving Cardiovascular Outcomes: Current Evidence and Perspectives. Cardiol Res Pract 2020; 2020:9815016. [PMID: 32670636 PMCID: PMC7338976 DOI: 10.1155/2020/9815016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/11/2020] [Indexed: 02/05/2023] Open
Abstract
Low-density lipoprotein lowering with statins has convincingly and consistently proven to reduce cardiovascular events in both primary and secondary prevention. However, despite high-dose statin therapy, residual cardiovascular risk remains and many patients also do not tolerate statins. Ezetimibe was initially projected as a frontline alternative to statin. It is an intestinal cholesterol absorption inhibitor with modest LDL lowering effects. But, major studies failed to demonstrate any beneficial effect of CV outcomes, and the drug was relegated to oblivion. IMPROVE-IT, a contemporary, large, and well-designed trial, unequivocally demonstrated reduction in CV outcomes with ezetimibe when added to statin therapy. The benefits are seen in both sexes, elderly, CKD, diabetes mellitus, and in patients with prior CABG. It also reduces biomarkers and induces plaque regression like statins. The drug has now established itself as an add-on therapy to statin when monotherapy fails to achieve LDL goals and when it is not tolerated. The combination therapy has excellent safety and efficacy record. It has now been endorsed by major guidelines too in management of dyslipidemia. Yes, ezetimibe can indeed improve cardiovascular outcomes!
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Tanner RM, Colantonio LD, Kilgore ML, Mefford MT, Chachappan DT, Mues KE, Safford MM, Rosenson RS, Muntner P. Low-density lipoprotein cholesterol levels among individuals experiencing statin-associated symptoms: Data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Clin Lipidol 2020; 14:720-729. [PMID: 32680814 PMCID: PMC9668077 DOI: 10.1016/j.jacl.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/22/2020] [Accepted: 06/07/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Guidelines recommend adults who discontinue statin therapy because of statin-associated symptoms be reinitiated. Low-density lipoprotein cholesterol (LDL-C) levels achieved after statin reinitiation are unknown. OBJECTIVE The objective of this study was to determine LDL-C levels after statin reinitiation. METHODS We analyzed data from 5498 participants in the REasons for Geographic And Racial Differences in Stroke study who reported ever taking a statin. We categorized participants according to their pattern of statin use including those taking a statin who did not experience statin-associated symptoms and continued treatment, and those who discontinued statins because of statin-associated symptoms and were not reinitiated, reinitiated and remained on treatment, and discontinued treatment after being reinitiated. Mortality and vascular event reduction with statin reinitiation was estimated using data from the Cholesterol-Lowering Treatment Trialists Collaboration. RESULTS After multivariable adjustment, LDL-C was 14.1 (95% CI: 9.9-18.3) mg/dL higher among participants reinitiated and taking a statin compared with those without statin-associated symptoms who continued statin therapy. Mean LDL-C was 18.1 mg/dL (95% CI: 13.0-23.1) and 27.5 mg/dL (95% CI: 20.7-34.4) lower among participants reinitiated and taking a statin compared with those who discontinued statin therapy and were not reinitiated and those who discontinued statins after being reinitiated, respectively. An LDL-C reduction of 18.1 mg/dL with statin reinitiation was projected to reduce all-cause and coronary heart disease mortality by 5.6% and 8.9%, respectively, and myocardial infarction or coronary heart disease death and major vascular events by 10.7% and 9.8%, respectively, over 5 years. CONCLUSION Reinitiating individuals who discontinue statin therapy may reduce LDL-C and cardiovascular risk.
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Affiliation(s)
- Rikki M Tanner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Lisandro D Colantonio
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meredith L Kilgore
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Matthew T Mefford
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dayl T Chachappan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Katherine E Mues
- The Center for Observational Research, Amgen Inc, Thousand Oaks, CA, USA
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Robert S Rosenson
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Wang J, Chi CL, St Peter WL, Carlson A, Loth M, Pradhan PM, Liang Y, Chen WY, Lenskaia T, Robinson JG, Adam TJ. A Population-Based Study of Simvastatin Drug-Drug Interactions in Cardiovascular Disease Patients. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2020; 2020:664-673. [PMID: 32477689 PMCID: PMC7233072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Simvastatin is a commonly used medication for lipid management and cardiovascular disease, however, the risk of adverse events (AEs) with its use increases via drug-drug interaction (DDI) exposures. Patients were extracted if initially diagnosed with cardiovascular disease and newly initiated simvastatin therapy. The cohort was divided into a DDI-exposed group and a non-DDI exposed group. The DDI-exposed group was further divided into gemfibrozil, clarithromycin, and erythromycin exposure groups. The outcome was defined as a composite of predefined AEs. Our results show that the simvastatin-DDI group had a higher illness burden with longer simvastatin exposure time and more medical care follow-up compared with the simvastatin-non-DDI exposed group. AEs occurred more frequently in subjects exposed to interacting drugs with a higher risk for clarithromycin and erythromycin exposed subjects than for gemfibrozil subjects.
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Affiliation(s)
- Jin Wang
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- OptumLabs Visiting Fellow, Cambridge, MA, USA
| | - Chih-Lin Chi
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
- OptumLabs Visiting Fellow, Cambridge, MA, USA
| | - Wendy L St Peter
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Angie Carlson
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Matt Loth
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
- OptumLabs Visiting Fellow, Cambridge, MA, USA
| | - Prajwal Mani Pradhan
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- OptumLabs Visiting Fellow, Cambridge, MA, USA
| | - Yue Liang
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- OptumLabs Visiting Fellow, Cambridge, MA, USA
| | - Wei-Yu Chen
- Department of Computer Science & Engineering, University of Minnesota, Minneapolis, MN, USA
- OptumLabs Visiting Fellow, Cambridge, MA, USA
| | - Tatiana Lenskaia
- Bioinformatics and Computational Biology program, University of Minnesota, Minneapolis, MN, USA
- OptumLabs Visiting Fellow, Cambridge, MA, USA
| | | | - Terrence J Adam
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
- College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
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Waddell KJ, Shah PD, Adusumalli S, Patel MS. Using Behavioral Economics and Technology to Improve Outcomes in Cardio-Oncology. JACC CardioOncol 2020; 2:84-96. [PMID: 34396212 PMCID: PMC8352113 DOI: 10.1016/j.jaccao.2020.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 02/03/2020] [Indexed: 12/20/2022] Open
Abstract
Patients with cancer are often at elevated risk for cardiovascular disease due to overlapping risk factors and cardiotoxic anticancer treatments. Their cancer diagnoses may be the predominant focus of clinical care, with less of an emphasis on concurrent cardiovascular risk management. Widely adopted technology platforms, including electronic health records and mobile devices, can be leveraged to improve the cardiovascular outcomes of these patients. These technologies alone may be insufficient to change behavior and may have greater impact if combined with behavior change strategies. Behavioral economics is a scientific field that uses insights from economics and psychology to help explain why individuals are often predictably irrational. Combining insights from behavioral economics with these scalable technology platforms can positively impact medical decision-making and sustained healthy behaviors. This review focuses on the principles of behavioral economics and how "nudges" and scalable technology can be used to positively impact clinician and patient behaviors.
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Affiliation(s)
- Kimberly J. Waddell
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Payal D. Shah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Srinath Adusumalli
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mitesh S. Patel
- Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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38
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Navar AM, Roe MT, White JA, Cannon CP, Lokhnygina Y, Newby LK, Giugliano RP, Tershakovec AM, Braunwald E, Califf RM, Blazing MA. Medication Discontinuation in the IMPROVE-IT Trial. Circ Cardiovasc Qual Outcomes 2020; 12:e005041. [PMID: 30630361 DOI: 10.1161/circoutcomes.118.005041] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although cholesterol-lowering medications can reduce the risk of recurrent cardiovascular events, premature discontinuation limits effectiveness. Discontinuation rates have not been systematically reported for lipid-lowering trials. METHODS AND RESULTS We evaluated medication discontinuation in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial), which evaluated placebo+simvastatin versus ezetimibe+simvastatin in patients hospitalized with the acute coronary syndrome and followed longitudinally postdischarge. Reasons for discontinuation were evaluated from randomization through study end (median 71.9 [interquartile range 51.8-85.8] months). Kaplan-Meier (KM) discontinuation rates were evaluated at 30 days, 1 year, and through year 7, and compared by treatment arm and region, with Cox proportional hazards modeling used to evaluate predictors of discontinuation. Overall, 46.7% of subjects discontinued study medication (KM rate by study end 50.9% [95% CI, 50.1%-51.7%]). The risk of discontinuation was highest early in the trial but decreased with increasing time, with a terminal KM rate per 100 person-years of 8.4 (8.2-8.6) from years 1 to 7. Discontinuation was higher in the placebo+simvastatin versus ezetimibe+simvastatin arm (KM rate 52.0% versus 49.8%, P=0.049) and was highest in the United States (7-year KM rate 57.4%). In multivariable modeling, smoking, prior revascularization, hypertension, unstable angina, female sex, nonwhite race, and US location were associated with higher discontinuation rates. CONCLUSIONS Although discontinuation was highest early and stabilized to 8% per year, because of prolonged follow-up, most discontinuation occurred after year 1. Adding ezetimibe to statin therapy did not increase discontinuation risk. Geographic differences and patient-level factors should be considered in trial design and analysis. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00202878.
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Affiliation(s)
- Ann Marie Navar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., M.T.R., J.A.W., Y.L., L.K.N., M.A.B.).,Duke Forge, Duke University, Durham, NC (A.M.N., R.M.C.)
| | - Matthew T Roe
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., M.T.R., J.A.W., Y.L., L.K.N., M.A.B.)
| | - Jennifer A White
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., M.T.R., J.A.W., Y.L., L.K.N., M.A.B.)
| | - Christopher P Cannon
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (C.P.C., R.P.G., E.B.)
| | - Yuliya Lokhnygina
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., M.T.R., J.A.W., Y.L., L.K.N., M.A.B.)
| | - L Kristin Newby
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., M.T.R., J.A.W., Y.L., L.K.N., M.A.B.)
| | - Robert P Giugliano
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., M.T.R., J.A.W., Y.L., L.K.N., M.A.B.).,TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (C.P.C., R.P.G., E.B.)
| | | | - Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (C.P.C., R.P.G., E.B.)
| | - Robert M Califf
- Duke Forge, Duke University, Durham, NC (A.M.N., R.M.C.).,Department of Medicine, Stanford University, CA (R.M.C.).,Verily Life Sciences, South San Francisco, CA (R.M.C.)
| | - Michael A Blazing
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.M.N., M.T.R., J.A.W., Y.L., L.K.N., M.A.B.)
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Drexel H, Coats AJS, Spoletini I, Bilato C, Mollace V, Perrone Filardi P, Rosano GMC. An expert opinion paper on statin adherence and implementation of new lipid-lowering medications by the ESC Working Group on Cardiovascular Pharmacotherapy: Barriers to be overcome. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 6:115-121. [DOI: 10.1093/ehjcvp/pvz079] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/28/2019] [Accepted: 12/20/2019] [Indexed: 12/18/2022]
Abstract
Abstract
Benefits and safety on statins have been well-established over 20 years of research. Despite this, the vast majority of patients are not adequately treated and do not achieve the low-density lipoprotein cholesterol target levels. This is mainly due to poor adherence, which is associated with dangerous and sometimes fatal outcomes. To increase adherence and prevent worse outcomes, a combination therapy with lower dosage of statins and new lipid-lowering drugs may be used. However, the implementation of new lipid-lowering drugs in European countries is still at the beginning. For these reasons, the aim of this position paper is to give an up-to-date indication from the ESC Working Group on Cardiovascular Pharmacotherapy in order to discuss the barriers towards statins adherence and new lipid-lowering drugs implementation in Europe.
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Affiliation(s)
- Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Division of Angiology, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Andrew J S Coats
- University of Warwick, Coventry CV4 7AL, UK
- Monash University, Melbourne, Australia
| | - Ilaria Spoletini
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Via della Pisana, 235, 00163 Rome, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy
| | - Vincenzo Mollace
- Institute for Food Safety & Health University, ‘Magna Graecia of Catanzaro’, Catanzaro, Italy
| | - Pasquale Perrone Filardi
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe M C Rosano
- Department of Medical Sciences, Centre for Clinical and Basic Research, IRCCS San Raffaele Pisana, Via della Pisana, 235, 00163 Rome, Italy
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40
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Vonbank A, Agewall S, Kjeldsen KP, Lewis BS, Torp-Pedersen C, Ceconi C, Funck-Brentano C, Kaski JC, Niessner A, Tamargo J, Walther T, Wassmann S, Rosano G, Schmidt H, Saely CH, Drexel H. Comprehensive efforts to increase adherence to statin therapy. Eur Heart J 2019; 38:2473-2479. [PMID: 28077470 DOI: 10.1093/eurheartj/ehw628] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/06/2016] [Indexed: 12/26/2022] Open
Affiliation(s)
- Alexander Vonbank
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Stefan Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Keld Per Kjeldsen
- Division of Cardiology, Department of Medicine, Copenhagen University Hospital (Holbaek Hospital), Holbaek, Denmark.,Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Basil S Lewis
- Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine of the Technion (Israel Institute of Technology), Haifa, Israel
| | - Christian Torp-Pedersen
- Health Science and Technology, Aalborg University, Niels Jernes Vej 12, A5-208, 9220 Aalborg, Denmark
| | - Claudio Ceconi
- University Hospital of Ferrara, U.O. Cardiologia, Post Degree School in Cardiology, Heart Failure and Cardiovascular Prevention Unit, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Christian Funck-Brentano
- INSERM, CIC-1421 and UMR ICAN 1166, AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology, Sorbonne Universités, UPMC Univ Paris, 06, Faculty of Medicine, F-75013 Paris, France
| | - Juan Carlos Kaski
- Cardiovascular Sciences Research Centre at St George's, University of London, Cranmer Terrace, London SW17 0RE, Great Britain
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Thomas Walther
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland.,Department of Obstetrics, Center for Perinatal Medicine, University of Leipzig, Leipzig, Germany
| | - Sven Wassmann
- Department of Cardiology, Isar Heart Center, Isarklinikum, Sonnenstr. 24-26, 80331 Munich, Germany
| | - Giuseppe Rosano
- Irccs San Raffaele Hospital, Department of Medical Sciences, Via Della Pisana 235, 00163 Rome, Italy
| | - Harald Schmidt
- Department of Health, Medicine and Life Sciences, Pharmacology, University of Maastricht Universiteitssingel 50, 6229 Maastricht, The Netzerlands
| | - Christoph H Saely
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Heinz Drexel
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein.,College of Medicine, Drexel University, Philadelphia, PA, USA
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Hu F, Warren J, Exeter DJ. Interrupted time series analysis on first cardiovascular disease hospitalization for adherence to lipid-lowering therapy. Pharmacoepidemiol Drug Saf 2019; 29:150-160. [PMID: 31788906 DOI: 10.1002/pds.4916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/04/2019] [Accepted: 10/11/2019] [Indexed: 11/08/2022]
Abstract
PURPOSE We analysed lipid-lowering medication adherence before and after the first hospitalization for cardiovascular disease (CVD) to explore the influence hospitalization has on patient medication adherence. METHODS We extracted a sub-cohort for analysis from 313,207 patients who had primary CVD risk assessment. Adherence was assessed as proportion of days covered (PDC) ≥ 80% based on community dispensing records. Adherence in the 4 quarters (360 days) before the first CVD hospitalization and 8 quarters (720 days) after hospital discharge was assessed for each individual in the sub-cohort. An interrupted time series design using generalized estimating equations was applied to compare the differences of population-level medication adherence rates before and after the first CVD hospitalization. RESULTS Overall, a significant improvement in medication adherence rate from before to after the hospitalization was observed (odds ratio (OR) 2.49 [1.74-3.57]) among the 946 patients included in the analysis. Patients having diabetes history had a higher OR of adherence before the hospitalization than patients without diabetes (1.50 [1.03-2.22]) but no significant difference after the hospitalization (OR 1.13 [0.89-1.43]). Before the first hospitalization, we observed that quarterly medication adherence rate was steady at around 55% (OR 0.97 [0.93-1.01), whereas the trend in adherence over the post-hospitalization period decreased significantly per quarter (OR 0.97 [0.94-0.99]). CONCLUSIONS Patients were more likely to adhere to lipid-lowering therapy after experiencing a first CVD hospitalization. The change in medication adherence rate is consistent with patients having heightened perception of disease severity following the hospitalization.
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Affiliation(s)
- Feiyu Hu
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Daniel J Exeter
- School of Population Health, University of Auckland, Auckland, New Zealand
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42
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Shau WY, Lai CL, Huang ST, Chen ST, Li JZ, Fung S, Tse VC, Lai MS. Statin adherence and persistence on secondary prevention of cardiovascular disease in Taiwan. HEART ASIA 2019; 11:e011176. [PMID: 31565075 DOI: 10.1136/heartasia-2018-011176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 01/29/2023]
Abstract
Background Evidence and treatment guidelines support the use of statins in patients with established atherosclerotic cardiovascular disease (ASCVD) for secondary prevention of subsequent cardiovascular (CV) event. However, treatment adherence and persistence are still a concern. Methods We constructed a retrospective population-based cohort of patients, who initiated statin treatment within 90 days after discharge from hospital for ASCVD using the claims database of Taiwan National Health Insurance. Proportion of days covered (PDC) was used to measure statin adherence, and PDC ≥80% was defined as good adherence. The study outcomes were subsequent rehospitalisation or in-hospital death due to composite ASCVD, myocardial infarction or ischaemic stroke. Their associations with statin prescription adherence or persistence were analysed using time-dependent Cox proportional hazards model. Results The study cohort included 185 252 postdischarge statin initiators. There were 50 015 subsequent ASCVD rehospitalisations including 2858 in-hospital death during 7 years of study period. Good adherence was significantly associated with lower risk of ASCVD rehospitalisation (adjusted HR (aHR) 0.90; 95% CI 0.87 to 0.92) and significantly lower risk of in-hospital death (aHR 0.59; 95% CI 0.53 to 0.65). Compared with constant use of statin, patients in the three less persistent states (recent stop, non-persistence and intermittent use) were associated with higher risk of subsequent ASCVD rehospitalisation, aHRs were 1.16, 1.13 and 1.26, respectively (all p<0.05). The increased risks were consistent with specific outcome of acute myocardial infarction and ischaemic stroke. Also, patients in the recent stop period had significantly higher risk for fatal CV event. Conclusions Good adherence and persistence to statin therapy are significantly associated with lower risk of secondary ASCVD rehospitalisation and in-hospital death.
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Affiliation(s)
- Wen-Yi Shau
- Medical Affairs, Pfizer Taiwan, New Taipei, Taiwan
| | - Chao-Lun Lai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine and Center for Critical Care Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Shih-Ting Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shu-Ting Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jim Z Li
- Global Health and Value, Pfizer, San Diego, California, USA
| | - Selwyn Fung
- APAC regional Medical Affairs, Pfizer, New York City, New York, USA
| | - Vicki C Tse
- APCER Life Sciences, Princeton, New Jersey, USA
| | - Mei-Shu Lai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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43
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Gadowski AM, Nanayakkara N, Heritier S, Magliano DJ, Shaw JE, Curtis AJ, Zoungas S, Owen AJ. Association between Dietary Intake and Lipid-Lowering Therapy: Prospective Analysis of Data from Australian Diabetes, Obesity, and Lifestyle Study (AusDiab) Using a Quantile Regression Approach. Nutrients 2019; 11:nu11081858. [PMID: 31405073 PMCID: PMC6724025 DOI: 10.3390/nu11081858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/01/2019] [Accepted: 08/08/2019] [Indexed: 02/07/2023] Open
Abstract
Lipid-lowering therapy (LLT) should be accompanied by dietary guidance for cardiovascular risk reduction; however, current evidence suggests sub-optimal dietary behaviors in those on LLT. We examined the associations between the dietary intake of key food groups (vegetables, fruit, cereal, protein, and dairy) and LLT use in Australian adults using quantile regression. We used data from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab), a prospective population-based study of adults aged ≥25 years, conducted over 5 years (1999-2005). Measurements included a 121-item food frequency questionnaire and LLT use. LLT use was categorized as: LLT users (n = 446), commenced LLT (n = 565), ceased LLT (n = 71), and non-users (n = 4813). Less than 1% of the cohort met recommended intakes of all food groups at the baseline and follow up. The median daily dietary intake at the follow up among LLT users was 2.2 serves of vegetables, 1.4 serves of fruit, 2.8 serves of cereal, 2.0 serves of protein, and 1.4 serves of dairy. Adjusted analysis showed no differences across the quantiles of intake of key food groups in LLT users and commenced LLT compared to non-users. The LLT medication status is not associated with any difference in meeting recommended intakes of key foods.
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Affiliation(s)
- Adelle M Gadowski
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Natalie Nanayakkara
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Stephane Heritier
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | | | - Jonathan E Shaw
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
| | - Andrea J Curtis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
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44
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Phelps GA, Qiao Y, Buckley MG, Wang J, Li MS, Bhuyan SS, Chisholm-Burns MA. Effects of the 2013 American College of Cardiology/American Heart Association guidelines on racial and ethnic disparities in statin treatment among diabetics. Res Social Adm Pharm 2019; 16:544-552. [PMID: 31371234 DOI: 10.1016/j.sapharm.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Significant racial and ethnic disparities in statin prescribing and utilization have been constantly documented. OBJECTIVE To examine whether racial/ethnic disparities in statin treatment have decreased among the diabetic population after the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. METHODS This retrospective study analyzed patients with diabetes aged 40-75 years old in the Medicare Expenditure Panel Survey (2011-2012 and 2014-2015). Racial and ethnic disparities in the likelihood of statin use and number of statin prescriptions were compared before and after the guideline release. Logistic and negative binomial regressions were used to adjust for patient characteristics. A difference-in-difference model (DID) was used to examine disparity changes. RESULTS This study included 2584 patients from 2011 to 2012 and 2610 from 2014 to 2015. During 2011-2012, racial/ethnic disparities were significant for the likelihood of statin use. For the number of statin prescriptions, racial disparity was significant, but not for the ethnic disparity. During 2014-2015, racial/ethnic disparities were significant for the likelihood of statin use but were not significant for the number of statin prescriptions. The DID model found that the 2013 guidelines were not associated with a reduction in racial and ethnic disparities in statin treatment. CONCLUSIONS This study found persistent disparities in the likelihood of statin use. The 2013 ACC/AHA guidelines were not associated with a reduction in racial and ethnic disparities in statin treatment.
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Affiliation(s)
- Gregory A Phelps
- University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Yanru Qiao
- University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Merrion G Buckley
- University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Junling Wang
- University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA.
| | - Minghui Sam Li
- University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
| | - Soumitra S Bhuyan
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, 33 Livingston Avenue, Rm 255, New Brunswick, NJ, 07920, USA
| | - Marie A Chisholm-Burns
- University of Tennessee College of Pharmacy, 881 Madison Avenue, Memphis, TN, 38163, USA
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Jüngst C, Gräber S, Simons S, Wedemeyer H, Lammert F. Medication adherence among patients with chronic diseases: a survey-based study in pharmacies. QJM 2019; 112:505-512. [PMID: 30840076 DOI: 10.1093/qjmed/hcz058] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 02/13/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Poor adherence to medication leads to worsening of the disease, increased mortality and substantial rise in health care costs. AIM It was our aim to evaluate drug adherence and influencing factors in a cohort of non-selected adult pharmacy customers with various chronic diseases and following long-term treatment. DESIGN AND METHODS We conducted an 8 week anonymized survey in 152 German pharmacies using the Morisky Medication Adherence Scale to measure medication adherence and a questionnaire comprising questions on multiple factors with potential impact on adherence. Depression was assessed applying the Patient Health Questionnaire-9. RESULTS In total, 1192 patients were included showing an overall adherence rate of 59.1%. A positive association to drug adherence was found in univariate analysis for non-smoking status, retirement, less disease related complaints, positive belief in drug effects, comprehensive knowledge about the disease and high quality of care by the physician and pharmacist. Multivariate regression analysis revealed that no or minimal depression (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.7-3.0), higher patient age (>63 years) (OR 2.2, CI 1.7-2.8), high perceived importance of the medication (OR 2.0, CI 1.5-2.6), good tolerability of the medication (OR 2.0, CI 1.2-3.5) and drug effect as expected or better (OR 1.6, CI 1.1-2.3) were positively correlated with adherence. CONCLUSIONS Suboptimal adherence to medication is common in pharmacy customers with chronic diseases. The determined factors influencing adherence may help to identify patients at risk for nonadherence and support the need of improvement in physicians' communication with patients to achieve adequate adherence rates.
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Affiliation(s)
- C Jüngst
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
- Deutsche Leberstiftung (German Liver Foundation), Essen/Hannover, Germany
| | - S Gräber
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg, Germany
| | | | - H Wedemeyer
- Deutsche Leberstiftung (German Liver Foundation), Essen/Hannover, Germany
- Department of Gastroenterology and Hepatology, Essen University Hospital, University of Duisburg-Essen, 45147 Essen, Germany
| | - F Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
- Deutsche Leberstiftung (German Liver Foundation), Essen/Hannover, Germany
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Gulayin PE, Lozada A, Beratarrechea A, Gutierrez L, Poggio R, Chaparro RM, Santero M, Masson W, Rubinstein A, Irazola V. An Educational Intervention to Improve Statin Use: Cluster RCT at the Primary Care Level in Argentina. Am J Prev Med 2019; 57:95-105. [PMID: 31128958 DOI: 10.1016/j.amepre.2019.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Statins are essential drugs for high cardiovascular disease (CVD) risk management; however, there is still low adherence to good clinical practice guidelines for statin use at the primary care level in low- and middle-income countries. This study aimed to test whether a complex intervention targeting physicians improves treatment and control of hypercholesterolemia among patients with moderate to high CVD risk in Argentina. STUDY DESIGN Cluster RCT. SETTING/PARTICIPANTS Ten primary care centers from the public healthcare system of Argentina. INTERVENTION Primary care physicians in the intervention group received an educational program with three main components: (1) an intensive 2-day training workshop; (2) educational outreach visits; and (3) a mobile health application installed on the physician's smartphones. MAIN OUTCOME MEASURES Reduction in mean low-density lipoprotein cholesterol level, reduction in mean Framingham risk score, proportion of patients receiving an appropriate statin dose, and mean annual number of primary care center visits. RESULTS Data were analyzed in 2017-2018. Between April 2015 and April 2016, a total of 357 participants were enrolled (179 patients in the intervention group and 178 in the control group). The global follow-up rate was 97.2%. At the end of the follow-up period, there was no difference in low-density lipoprotein cholesterol levels in any of the follow-up points among the groups. Mean CVD risk had a significant net difference in the first 6 months in the intervention group versus the control group (-4.0, 95% CI = -6.5, -1.5). At the end of follow-up, there was an absolute 41.5% higher rate of participants receiving an appropriate statin dose in the intervention group versus the control group. CONCLUSIONS Although the intervention did not reach a reduction in cholesterol levels, it had a significant positive impact on the promotion of adequate use of clinical practice guidelines. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02380911.
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Affiliation(s)
- Pablo E Gulayin
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina.
| | | | - Andrea Beratarrechea
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
| | - Laura Gutierrez
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
| | - Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
| | - Raúl Martín Chaparro
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
| | - Marilina Santero
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
| | - Walter Masson
- Buenos Aires Italiano Hospital, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina
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Phan DQ, Duan L, Lam B, Hekimian A, Wee D, Zadegan R, Lee MS. Statin Adherence and Mortality in Patients Aged 80 Years and Older After Acute Myocardial Infarction. J Am Geriatr Soc 2019; 67:2045-2049. [PMID: 31206603 DOI: 10.1111/jgs.16037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND/OBJECTIVES The goal of this study was to describe the pattern of statin adherence in older patients, aged 80 years or older; identify factors associated with high adherence; and determine the association between statin adherence and all-cause mortality. DESIGN Retrospective population-based cohort study. SETTING An integrated healthcare system in Southern California. PARTICIPANTS Patients hospitalized with a principal diagnosis of acute myocardial infarction (MI) between January 1, 2006, and December 31, 2016. MEASUREMENTS Statin adherence, as measured using pharmacy dispensing records over the 365 days following hospital discharge, based on proportion of days covered (PDC). Adherence levels were categorized as high (PDC 80% or higher), partial (PDC 40% or higher and lower than 80%), and low (PDC lower than 40%). RESULTS Between 2006 and 2016, 5629 patients, 80 years or older, hospitalized for acute MI met the inclusion criteria. Among this group, 68.8% were highly adherent to statin therapy, 20.4% were partially adherent, and 10.8% were not adherent. Male sex (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.25-1.62) and white race (OR = 1.35; 95% CI = 1.18-1.55) were associated with high statin adherence. Follow-up was 4.3 ± 2.6 years. Both low and partial adherence were associated with increase mortality (low adherence: adjusted hazard radio [HR] = 1.12; 95% CI = 1.01-1.25; partial adherence: adjusted HR = 1.22; 95% CI = 1.12-1.32). CONCLUSIONS In older patients, aged 80 years or older, high adherence to statins after MI was associated with improved survival. This association may not have been due only to adherence to statins but to other related factors as well. Findings from this study may inform discussions on the potential benefits of statin adherence. J Am Geriatr Soc 67:2045-2049, 2019.
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Affiliation(s)
- Derek Q Phan
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Lewei Duan
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Bryan Lam
- Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Avetis Hekimian
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - David Wee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Ray Zadegan
- Department of Interventional Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
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Hu F, Warren J, Exeter DJ. Geography and patient history in long-term lipid lowering medication adherence for primary prevention of cardiovascular disease. Spat Spatiotemporal Epidemiol 2019; 29:13-29. [DOI: 10.1016/j.sste.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 10/03/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
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Stasinopoulou M, Kadoglou NPE, Christodoulou E, Paronis E, Kostomitsopoulos NG, Valsami G, Liapis CD, Kakisis J. Statins’ Withdrawal Induces Atherosclerotic Plaque Destabilization in Animal Model—A “Rebound” Stimulation of Inflammation. J Cardiovasc Pharmacol Ther 2019; 24:377-386. [DOI: 10.1177/1074248419838499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Marianna Stasinopoulou
- Center of Clinical, Experimental Surgery, and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Nikolaos P. E. Kadoglou
- Centre for Statistics in Medicine—Botnar Research Centre, University of Oxford, Oxford, United Kingdom
| | - Eirini Christodoulou
- Department of Pharmacy, Laboratory of Biopharmaceutics-Pharmacokinetics, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthymios Paronis
- Center of Clinical, Experimental Surgery, and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Nikolaos G. Kostomitsopoulos
- Center of Clinical, Experimental Surgery, and Translational Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Georgia Valsami
- Department of Pharmacy, Laboratory of Biopharmaceutics-Pharmacokinetics, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos D. Liapis
- Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
Statins are the main treatment for hypercholesterolemia and the cornerstone of atherosclerotic cardiovascular disease prevention. Many patients taking statins report muscle-related symptoms, one of the most important causes of statin treatment discontinuation, which is associated with an increased risk of cardiovascular events. Therefore, it is important to identify patients who are truly statin intolerant to avoid unnecessary discontinuation of this beneficial treatment. Some studies indicate that not all muscle complaints are caused by statins, and most patients can tolerate a statin upon re-challenge, down-titration of dose, or switching to another statin. In this paper, we review the definitions of statin intolerance and approaches to reducing cardiovascular risk among individuals reporting statin-associated muscle symptoms.
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Affiliation(s)
| | - Ada Cuevas
- Department of Nutrition, Clinica Las Condes
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