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Are High-Risk Hypertensive Patients being Prescribed Concomitant Statin Therapy?

A Retrospective Cohort Study

  • Original Research Article
  • Published:
American Journal of Cardiovascular Drugs Aims and scope Submit manuscript

Abstract

Background

Treatment guidelines for dyslipidemic patients have focused on lipid levels and risk assessments. However, normolipidemic patients who have multiple risk factors for cardiovascular disease may also benefit from HMG-CoA reductase inhibitor (statin) therapy.

Objective

We examined the frequency of statin prescriptions in patients initiating antihypertensive drug treatment in a US managed-care setting.

Study Design and Patients

This retrospective cohort study used the PharMetrics’ Patient-Centric Database to identify enrollees initiating antihypertensive treatment (September 2001 to February 2004). Patients newly treated with antihypertensives and with various levels of coronary heart disease (CHD) risk (including dyslipidemia, established CHD, type 2 diabetes mellitus, and no CHD but three or more cardiovascular risk factors) were included in the study.

Main Outcome Measure

Cumulative probability of receiving statin therapy each month after antihypertensive initiation. Multivariable logistic regression was used to identify factors associated with receiving concomitant statin therapy.

Results

Of 142 389 patients (mean age 51.7 years) newly treated with antihypertensives, 32 056 (22.5%) were prescribed statins within 1 year. The cumulative probability of being prescribed a statin increased with increasing numbers of CHD risk factors, irrespective of dyslipidemia status. After adjusting for age, sex, and other potential predictors, patients were more likely to receive statin therapy if they had a history of dyslipidemia (adjusted odds ratio [AOR] 5.68 [95% CI 5.52, 5.85]), established CHD/congestive heart failure (AOR 3.39 [95% CI 3.16, 3.63]), or three or more additional cardiovascular risk factors but no CHD (AOR 3.01 [95% CI 2.74, 3.30]).

Conclusion

Among patients beginning antihypertensive treatment, those with established CHD or CHD risk factors were more likely to receive statins, but a substantial fraction did not fill any statin prescription. The increased use of statin therapy could benefit many hypertensive patients with additional CHD risk factors.

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References

  1. Baxter C, Jones R, Corr L. Time trend analysis and variations in prescribing lipid lowering drugs in general practice. BMJ 1998; 317(7166): 1134–5.

    Article  PubMed  CAS  Google Scholar 

  2. Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285(19): 2486–97.

    Article  Google Scholar 

  3. Ma J, Sehgal NL, Ayanian JZ, et al. National trends in statin use by coronary heart disease risk category. PLoS Med 2005; 2(5): e123.

    Article  PubMed  Google Scholar 

  4. Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics-2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007; 115(5): e69–171.

    Article  PubMed  Google Scholar 

  5. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial Investigators. N Engl J Med 1996; 335(14): 1001–9.

    Article  PubMed  CAS  Google Scholar 

  6. Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350(15): 1495–504.

    Article  PubMed  CAS  Google Scholar 

  7. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110(2): 227–39.

    Article  PubMed  Google Scholar 

  8. Koren MJ, Hunninghake DB. Clinical outcomes in managed-care patients with coronary heart disease treated aggressively in lipid-lowering disease management clinics: the ALLIANCE study. J Am Coll Cardiol 2004; 44(9): 1772–9.

    PubMed  Google Scholar 

  9. LaRosa JC, Grundy SM, Kastelein JJ, et al. Safety and efficacy of atorvastatininduced very low-density lipoprotein cholesterol levels in patients with coronary heart disease (a post hoc analysis of the Treating to New Targets [TNT] study). Am J Cardiol 2007; 100(5): 747–52.

    Article  PubMed  CAS  Google Scholar 

  10. LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005; 352(14): 1425–35.

    Article  PubMed  CAS  Google Scholar 

  11. Erhardt L, Moller RA, García Puig J. Comprehensive cardiovascular risk management: what does it mean in practice? Vascular Health Risk Manag 2007; 3(5): 587–603.

    Google Scholar 

  12. Kostis JB. The importance of managing hypertension and dyslipidemia to decrease cardiovascular disease. Cardiovasc Drugs Ther 2007; 21(4): 297–309.

    Article  PubMed  Google Scholar 

  13. Erhardt LR, Leiter LA, Hobbs RFD. Lipid management in cardiovascular disease prevention guidelines: strategies and tactics for implementation. Atherosclerosis 2008; 196(2): 532–41.

    Article  PubMed  CAS  Google Scholar 

  14. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002; 360(9326): 7–22.

    Article  Google Scholar 

  15. Sever PS, Dahlöf B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003; 361(9364): 1149–58.

    Article  PubMed  CAS  Google Scholar 

  16. Williams B. Recent hypertension trials: implications and controversies. J Am Coll Cardiol 2005; 45(6): 813–27.

    Article  PubMed  Google Scholar 

  17. Williams B, Poulter NR, Brown MJ, et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ 2004; 328(7440): 634–40.

    Article  PubMed  Google Scholar 

  18. Joyce AT, Harrison DJ, Loebel AD, et al. Impact of atypical antipsychotics on outcomes of care in schizophrenia. Am J Manag Care 2005; 11 (8 Suppl.): S254–61.

    PubMed  Google Scholar 

  19. Dubois RW, Alexander CM, Wade S, et al. Growth in use of lipid-lowering therapies: are we targeting the right patients? Am J Manag Care 2002; 8(10): 862–7.

    PubMed  Google Scholar 

  20. Dutro MP, Gerthoffer TD, Peterson ED, et al. Treatment of hypertension and dyslipidemia or their combination among US managed-care patients. J Clin Hypertens (Greenwich) 2007; 9(9): 684–91.

    Article  Google Scholar 

  21. Foody JM, Joyce AT, Rudolph AE, et al. Statin utilization among patients with prior cardiovascular events. XVI International Symposium on Drugs Affecting Lipid Metabolism; 2007 Oct 4–7; New York.

  22. Greving JP, Denig P, de Zeeuw D, et al. Trends in hyperlipidemia and hypertension management in type 2 diabetes patients from 1998–2004: a longitudinal observational study. Cardiovasc Diabetol 2007; 6: 25.

    Article  PubMed  Google Scholar 

  23. DeWilde S, Carey IM, Bremner SA, et al. Evolution of statin prescribing 1994–2001: a case of agism but not of sexism? Heart 2003; 89(4): 417–21.

    Article  PubMed  CAS  Google Scholar 

  24. Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360(9346): 1623–30.

    Article  PubMed  CAS  Google Scholar 

  25. Wenger NK, Lewis SJ, Herrington DM, et al. Outcomes of using high- or low-dose atorvastatin in patients 65 years of age or older with stable coronary heart disease. Ann Intern Med 2007; 147(1): 1–9.

    PubMed  Google Scholar 

  26. Hickling J, Rogers S, Nazareth I. Barriers to detecting and treating hypercholesterolaemia in patients with ischaemic heart disease: primary care perceptions. Br J Gen Pract 2005; 55(516): 534–8.

    PubMed  Google Scholar 

  27. Jackevicius CA, Tu K, Filate WA, et al. Trends in cardiovascular drug utilization and drug expenditures in Canada between 1996 and 2001. Can J Cardiol 2003; 19(12): 1359–66.

    PubMed  Google Scholar 

  28. Min LC, Wenger NS, Fung C, et al. Multimorbidity is associated with better quality of care among vulnerable elders. Med Care 2007; 45(6): 480–8.

    Article  PubMed  Google Scholar 

  29. Higashi T, Wenger NS, Adams JL, et al. Relationship between number of medical conditions and quality of care. N Engl J Med 2007; 356(24): 2496–504.

    Article  PubMed  CAS  Google Scholar 

  30. Lagu T, Weiner MG, Hollenbeak CS, et al. The impact of concordant and discordant conditions on the quality of care for hyperlipidemia. J Gen Intern Med 2008; 23(8): 1208–13.

    Article  PubMed  Google Scholar 

  31. Turner BJ, Hollenbeak CS, Weiner M, et al. Effect of unrelated comorbid conditions on hypertension management. Ann Intern Med 2008; 148(8): 578–86.

    PubMed  Google Scholar 

  32. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366(9493): 1267–78.

    Article  PubMed  CAS  Google Scholar 

  33. Muldoon MF, Manuck SB, Mendelsohn AB, et al. Cholesterol reduction and non-illness mortality: meta-analysis of randomised clinical trials. BMJ 2001; 322(7277): 11–5.

    Article  PubMed  CAS  Google Scholar 

  34. Graham DJ, Staffa JA, Shatin D, et al. Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. JAMA 2004; 292(21): 2585–90.

    Article  PubMed  CAS  Google Scholar 

  35. Steinman MA, Fischer MA, Shlipak MG, et al. Clinician awareness of adherence to hypertension guidelines. Am J Med 2004; 117(10): 747–54.

    Article  PubMed  Google Scholar 

  36. Wolf-Maier K, Cooper RS, Kramer H, et al. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension 2004; 43(1): 10–7.

    Article  PubMed  CAS  Google Scholar 

  37. Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report. JAMA 2003; 289(19): 2560–72.

    Article  PubMed  CAS  Google Scholar 

  38. Ray KK, Cannon CP, McCabe CH, et al. Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes: results from the PROVE IT-TIMI 22 trial. J Am Coll Cardiol 2005; 46(8): 1405–10.

    Article  PubMed  CAS  Google Scholar 

  39. Sever PS, Poulter NR, Dahlöf B, et al. Different time course for prevention of coronary and stroke events by atorvastatin in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA). Am J Cardiol 2005; 96(5A): 39–44F.

    Article  Google Scholar 

  40. Chapman RH, Benner JS, Petrilla AA, et al. Predictors of adherence with antihypertensive and lipid-lowering therapy. Arch Intern Med 2005; 165(10): 1147–52.

    Article  PubMed  Google Scholar 

  41. Agarwal S, Tang SS, Rosenberg N, et al. Does synchronizing initiation of therapy affect adherence to concomitant use of antihypertensive and lipid-lowering therapy? Am J Ther 2009; 16(2): 119–26.

    Article  PubMed  Google Scholar 

  42. Goldberg RB, Mellies MJ, Sacks FM, et al. Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the Cholesterol And Recurrent Events (CARE) trial. The CARE Investigators. Circulation 1998; 98(23): 2513–9.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was sponsored by Pfizer Inc., New York, NY, USA.

Editorial support was provided by Karen Burrows of Envision Pharma and funded by Pfizer Inc. Dr Richard H. Chapman and Allison A. Petrilla are employees of IMS Health. Joshua S. Benner was an employee of IMS Health when this study was conducted. Drs Richard H. Chapman, Joshua S. Benner, and Allison A. Petrilla were paid consultants to Pfizer Inc. in connection with the development of the manuscript. Lance Berman and Simon S.K. Tang are employees of Pfizer Inc.

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Authors and Affiliations

  1. US Health Economics and Outcomes Research, IMS Health, 300 N. Washington Street, Suite 303, Falls Church, Virginia, VA 22046, USA

    Richard H. Chapman (Principal), Allison A. Petrilla & Joshua S. Benner

  2. Pfizer Inc., New York, New York, USA

    Lance Berman & Simon S. K. Tang

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  1. Richard H. Chapman
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  2. Allison A. Petrilla
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Correspondence to Richard H. Chapman.

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Chapman, R.H., Petrilla, A.A., Berman, L. et al. Are High-Risk Hypertensive Patients being Prescribed Concomitant Statin Therapy?. Am J Cardiovasc Drugs 9, 299–308 (2009). https://doi.org/10.2165/11312110-000000000-00000

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