NDLI: Cholesterol level goal attainment with statins: clinical management guideline recommendations versus management in actual clinical practice.

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Cholesterol level goal attainment with statins: clinical management guideline recommendations versus management in actual clinical practice.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Heintjes, Edith M. Penning-van Beest, Fernie J. A. Plat, Arian W. Meerding, Willem Jan Webb, Kate Sturkenboom, Miriam C. Herings, Ron M. C.
Spatial Coverage	Netherlands
Description	Country affiliation: Netherlands Author Affiliation: Heintjes EM ( PHARMO Institute, Utrecht, the Netherlands. edith.heintjes@pharmo.nl)
Abstract	STUDY OBJECTIVES: To compare the cholesterol level goal attainment rates in patients receiving simvastatin doses recommended in clinical practice guidelines and simvastatin doses most frequently prescribed in clinical practice versus other statins at various dose levels, and to assess statin adherence rates in patients receiving all statins. DESIGN: Retrospective cohort study. DATA SOURCE: PHARMO database, which contains linked prescription drug information, hospitalization records, and laboratory test results of over 1 million patients in the Netherlands. PATIENTS: A total of 7355 new statin users with available cholesterol level measurements before and 12 months after starting statin treatment between 1999 and 2006. MEASUREMENTS AND MAIN RESULTS: Simvastatin was chosen as the reference drug because policy makers in the Netherlands have promoted the use of generically available statins to reduce costs. Cholesterol level goal attainment rates were compared in patients receiving simvastatin 40 mg/day, which was the statin dose promoted in the 2006 Dutch cardiovascular risk management guidelines, or simvastatin 20 mg/day, which was the most frequently prescribed dose up to 2006, versus other statins at various dose levels. Relative risks (RRs) were adjusted for age, sex, year of therapy initiation, cardiovascular disease, type 2 diabetes mellitus, hypertension, baseline low-density lipoprotein cholesterol level, and adherence during the 3 months before the 12-month follow-up cholesterol measurement. Compared with simvastatin 40 mg/day, cholesterol goal attainment rates were significantly higher with atorvastatin 40 mg/day (RR 1.15, 95% confidence interval [CI] 1.04-1.28) and rosuvastatin 10 mg/day (RR 1.13, 95% CI 1.04-1.23), were similar with atorvastatin 20 mg/day (RR 1.06, 95% CI 0.97-1.16) and rosuvastatin 20 mg/day (RR 1.14, 95% CI 0.93-1.39), and were significantly lower with all other frequently used statin dose levels. Compared with simvastatin 20 mg/day, cholesterol goal attainment was significantly higher with any dose of atorvastatin and rosuvastatin, but were lower with any dose of pravastatin. Goal attainment rates were similar among patients with lower and higher cardiovascular risk. Among the 13-18% of patients who had follow-up cholesterol level measurements at 12 months in all statin groups, the proportion of adherent patients was approximately 75%; this was higher than the proportion of adherent patients in the total population (48-55%), which included patients without follow-up cholesterol levels. CONCLUSION: A larger proportion of patients reached cholesterol lipid goals with simvastatin 40 mg/day. Cholesterol level goals were achieved by many patients using the recommended simvastatin 40 mg/day, but by fewer patients among those using the more commonly prescribed simvastatin 20 mg/day. Therefore, especially in high-risk patients, the choice of statin should be based on baseline cholesterol levels and expected reductions in these levels, and treatment should be adapted if targets are not met. Improved cholesterol level monitoring may increase adherence and cholesterol management.
File Format	HTM / HTML
ISSN	02770008
Issue Number	7
Volume Number	32
e-ISSN	18759114
Journal	Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2012-07-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Pharmacology Cardiovascular Diseases Prevention & Control Cholesterol Blood Hydroxymethylglutaryl-coa Reductase Inhibitors Therapeutic Use Simvastatin Aged Atorvastatin Calcium Etiology Cohort Studies Databases, Factual Dose-response Relationship, Drug Female Fluorobenzenes Administration & Dosage Follow-up Studies Heptanoic Acids Humans Male Medication Adherence Middle Aged Netherlands Practice Guidelines As Topic Pravastatin Pyrimidines Pyrroles Retrospective Studies Risk Rosuvastatin Calcium Sulfonamides Comparative Study Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Pharmacology (medical)

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