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Patients at high CV risk often started on moderate-dose statins
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Many patients at high CV risk were initially prescribed moderate-dose statins for LDL lowering and CVD prevention, and they were usually not up-titrated, according to a retrospective analysis.
Researchers examined administrative claims data for 92,621 patients (mean age, 65 years; 57% men) diagnosed with atherosclerotic CVD or familial hypercholesterolemia (FH) who initiated therapy with a statin or ezetimibe (Zetia, Merck) between 2007 and 2012.
James P. Burke, PhD, a health economics and outcomes researcher with Optum Inc., and colleagues followed the patients for as long as 3 years or four treatment episodes, documenting the initial medication regimen and any treatment modifications, including discontinuation, dosage changes, switching therapies or adding therapies.
Most patients with atherosclerotic CVD (89.6%) and FH (85.8%) begun therapy with a statin alone, with 68.2% of those with atherosclerotic CVD and 71.1% of those with FH starting with moderate-dose statins, according to the researchers.
The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommends patients with high CV risk, including those with atherosclerotic CVD, be prescribed high-dose statin therapy, the researchers wrote in the study background.
In the first treatment episode, the most common modification was discontinuation of therapy, occurring in 42% of those with atherosclerotic CVD and 58.4% of those with FH, Burke and colleagues wrote.
Of those who discontinued therapy, 70.5% of those with atherosclerotic CVD and 76.8% of those with FH eventually resumed therapy.
Increasing of statin doses in the first treatment episode occurred during the study period in 10.3% of patients with atherosclerotic CVD and 18.5% of patients with FH, according to the researchers.
“In light of the recent ACC/AHA guidelines, statin initiation practices will need to change in order to ensure appropriate therapy for high-risk patients,” Burke and colleagues wrote. – by Erik Swain
Disclosure: The study was funded by Amgen. Burke and another researcher report being employed by Optum Inc., which has a research contract with Amgen. Two researchers report being employed by Amgen. One researcher reports consulting for Amgen, Merck and Pfizer.
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