Statin prescription strategies and atherogenic cholesterol goals attainment in Lebanese coronary artery disease patients
Background Current guidelines recommend a low-density lipoprotein cholesterol goal of <1.8 mmol/L (<70 mg/dL) and a non high-density lipoprotein cholesterol (non-HDL-C) goal of <2.6 mmol/L (<00 mg/dL) for coronary artery disease (CAD) patients. Objective This study aimed to describe real-life statin prescription strategies and to assess their effectiveness in terms of LDL-C and non-HDL-C goals attainment in a cohort of CAD patients. Setting Outpatient cardiology specialty clinics located in main Lebanese cities. Methods This is a retrospective crosssectional study. Eligible patients were those who had established CAD, treated with statins and having complete follow-up lipid panel at least 3 months from statin prescription. The following statin prescription strategies were considered in data analysis: prescription of different intensity statin as monotherapy, prescription of a statin in combination with: a low fat diet, another lipid-altering agent and another lipidaltering agent plus a low fat diet. Main outcome measure LDL-C goal attainment for each of the statin prescription strategy. Results Of the 423 CAD statin-treated patients, only 38.5 and 36.6% attained their recommended LDL-C and non-HDL-C goals, respectively. Using a statin in combination with ezetimibe or with another lipid-altering agent plus a low fat diet were significantly associated with LDL-C and non-HDL-C goals attainment. Conclusion Improvement of statin prescription strategies, such as using regular and scheduled dosage of high-intensity statins and combining statin therapy with ezetimibe, is therefore required when managing patients with CAD.
KeywordsGuidelines Hypercholesterolemia LDL Lebanon Prescribing Statins
SL, DS, FY have contributed to the conception of the study, data collection, data analysis, final revision and approval for publication.
Conflicts of interest
Authors do not have any conflicts of interest to declare.
- 1.WHO The top 10 causes of death [Internet]. [cited 2016 Jun 7]. http://www.who.int/mediacentre/factsheets/fs310/en/.
- 2.Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124:2458–73.CrossRefPubMedGoogle Scholar
- 9.Armitage J, Bowman L, Wallendszus K, Bulbulia R, Rahimi K, Haynes R, Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH) Collaborative Group, et al. Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12, 064 survivors of myocardial infarction: a double-blind randomized trial. Lancet. 2010;376:1658–69.CrossRefPubMedGoogle Scholar
- 10.Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, et al. Cholesterol treatment trialists’ (CTT) collaboration, efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomized trials. Lancet. 2010;376(9753):1670–81.CrossRefPubMedGoogle Scholar
- 11.Hsia J, MacFadyen JG, Monyak J, Ridker PM. Cardiovascular event reduction and adverse events among subjects attaining low-density lipoprotein cholesterol <50 mg/dL with rosuvastatin: the JUPITER trial (justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin. J Am Coll Cardiol. 2011;57(16):1666–75.CrossRefPubMedGoogle Scholar
- 15.Bongarda V, Dallongeville J, Arveilerd D, Ruidavetsa JB, Amouyel P, Wagnerd A, et al. Attainment of low-density lipoprotein cholesterol target in the French general population according to levels of cardiovascular risk: insights from the MONA LISA study. Arch Cardiovasc Dis. 2013;106(2):93–102.CrossRefGoogle Scholar
- 16.Al Sifri SN, Almahmeed W, Azar S, Okkeh O, Bramlage P, Jünger C, et al. Results of the Dyslipidemia International Study (DYSIS)-Middle East: clinical perspective on the prevalence and characteristics of lipid abnormalities in the setting of chronic statin treatment. PLoS ONE. 2014;9(1):e84350.CrossRefPubMedPubMedCentralGoogle Scholar
- 17.García-Gil M, Blanch J, Comas-Cufí M, Daunis-I-Estadella J, Bolíbar B, Martí R. Strategies of statin use and cholesterol goal attainment in a high-risk cardiovascular population: a retrospective study of primary care electronic medical records. J Clin Lipidol. 2016;10(1):134–42.CrossRefPubMedGoogle Scholar
- 22.Rallidis LS, Kotakos C, Sourides V, Varounis C, Charalampopoulos A, Zolindaki M, et al. Attainment of optional low-density lipoprotein cholesterol goal of less than 70 mg/dL and impact on prognosis of very high risk stable coronary patients: a 3-year follow-up. Expert Opin Pharmacother. 2011;12(10):1481–9.CrossRefPubMedGoogle Scholar
- 24.Pearson TA, Laurora I, Chu H, Kafonek S. The lipid treatment assessment project (L-TAP): a multicenter survey to evaluate the percentage of dyslipidemic patients receiving lipid lowering therapy and achieving low density lipoprotein cholesterol goals. Arch Intern Med. 2000;160(4):459–67.CrossRefPubMedGoogle Scholar
- 33.Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (study of heart and renal protection): a randomized placebo-controlled trial. Lancet. 2011;377(9784):2181–92.CrossRefPubMedPubMedCentralGoogle Scholar