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International Journal of Clinical Pharmacy

, Volume 39, Issue 4, pp 919–926 | Cite as

Statin prescription strategies and atherogenic cholesterol goals attainment in Lebanese coronary artery disease patients

  • Soubra Lama
  • Domiati Souraya
  • Fattouh Youssef
Research Article

Abstract

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.

Keywords

Guidelines Hypercholesterolemia LDL Lebanon Prescribing Statins 

Notes

Author contributions

SL, DS, FY have contributed to the conception of the study, data collection, data analysis, final revision and approval for publication.

Funding

None.

Conflicts of interest

Authors do not have any conflicts of interest to declare.

References

  1. 1.
    WHO The top 10 causes of death [Internet]. [cited 2016 Jun 7]. http://www.who.int/mediacentre/factsheets/fs310/en/.
  2. 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
  3. 3.
    Jacobson TA. ‘Trig-onometry’: non-high-density lipoprotein cholesterol as a therapeutic target in dyslipidaemia. Int J Clin Pract. 2011;65(1):82–101.CrossRefPubMedGoogle Scholar
  4. 4.
    Mahajan N, Ference BA, Arora N, Madhavan R, Bhattacharya P, Sudhakar R, et al. Role of non-high-density lipoprotein cholesterol in predicting cerebrovascular events in patients following myocardial infarction. Am J Cardiol. 2012;109(12):1694–9.CrossRefPubMedGoogle Scholar
  5. 5.
    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.CrossRefGoogle Scholar
  6. 6.
    Cannon CP, Braunwald E, McCabe CH, Rader CJ, Rouleau JL, Belder R, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350:1495–504.CrossRefPubMedGoogle Scholar
  7. 7.
    La Rosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005;352:1425–35.CrossRefGoogle Scholar
  8. 8.
    Pedersen TR, Faergeman O, Kastelein JJP, Olsson AG, Tikkanen MJ, Holme I, et al. Highdose atorvastatin versus usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA. 2005;294(19):2437–45.CrossRefPubMedGoogle Scholar
  9. 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. 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. 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
  12. 12.
    Reiner Z, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, et al. ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2011;32:1769–818.CrossRefPubMedGoogle Scholar
  13. 13.
    Jones PH, Nair R, Thakker KM. Prevalence of dyslipidemia and lipid goal attainment in statin-treated subjects from 3 data sources. A retrospective analysis. J Am Heart Assoc. 2012;1(6):e001800.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Gitt AK, Drexel H, Feely J, Ferrières J, Gonzalez-Juanatey JR, Thomsen KK, et al. Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal attainment in clinical practice in Europe and Canada. Eur J Prev Cardiol. 2012;19:221–30.CrossRefPubMedGoogle Scholar
  15. 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. 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. 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
  18. 18.
    Goldenberg N, Glueck C. Efficacy, effectiveness and real life goal attainment of statins in managing cardiovascular risk. Vasc Health Risk Manag. 2009;5(1):369–76.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. J Am Coll Cardiol. 2014;63:2889–934.CrossRefPubMedGoogle Scholar
  20. 20.
    Ho KT, Chin KW, Ng KS, Alemao E, Rajagopalan S, Yin D. The A-SACT (attainment in Singapore of cholesterol targets) study in patients with coronary heart disease. Am J Cardiovasc Drugs. 2006;6(6):383–91.CrossRefPubMedGoogle Scholar
  21. 21.
    Xanthopoulou I, Davlouros P, Siahos S, Perperis A, Zaharioglou E, Alexopoulos D. First-line treatment strategies and lipid target levels attainment in very high cardiovascular risk outpatients. Lipids Health Dis. 2013;12:170.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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
  23. 23.
    Goodman SG, Langer A, Bastien NR, McPherson R, Francis GA, Genest JJ, et al. Prevalence of dyslipidemia in statin treated patients in Canada: results of the Dyslipidemia International Study (DYSIS). Can J Cardiol. 2010;26(9):330–5.CrossRefGoogle Scholar
  24. 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
  25. 25.
    Bourgault C, Davignon J, Fodor G, Gagné C, Gaudet D, Genest J, et al. Statin therapy in Canadian patients with hypercholesterolemia: the Canadian Lipid Study-Observational (CALIPSO). Can J Cardiol. 2005;21(13):1187–93.PubMedGoogle Scholar
  26. 26.
    Nichols GA, Koro CE. Does statin therapy initiation increase the risk for myopathy? An observational study of 32,225 diabetic and nondiabetic patients. Clin Ther. 2007;29(8):1761–70.CrossRefPubMedGoogle Scholar
  27. 27.
    Vaughan CJ, Gotto AM Jr. Update on statins: 2003. Circulation. 2004;110(7):886–92.CrossRefPubMedGoogle Scholar
  28. 28.
    Illingworth DR. Management of hypercholesterolemia. Med Clin N Am. 2000;84(1):23–42.CrossRefPubMedGoogle Scholar
  29. 29.
    Chinwong D, Patumanond J, Chinwong S, Siriwattana K, Gunaparn S, Hall JJ, et al. Statin therapy in patients with acute coronary syndrome: low-density lipoprotein cholesterol goal attainment and effect of statin potency. Ther Clin Risk Manag. 2015;11:127–36.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Davidson MH. Reducing residual risk for patients on statin therapy: the potential role of combination therapy. Am J Cardiol. 2005;96(9A):3K–13K.CrossRefPubMedGoogle Scholar
  31. 31.
    Karalis DG, Victor B, Ahedor L, Liu L. Use of lipid-lowering medications and the likelihood of achieving optimal LDL-cholesterol goals in coronary artery disease patients. Cholesterol. 2012;2012:861924. doi: 10.1155/2012/861924.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372:2387–97.CrossRefPubMedGoogle Scholar
  33. 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
  34. 34.
    Mok HY, von Bergmann K, Grundy SM. Effects of continuous and intermittent feeding on biliary lipid outputs in man: application for measurements of intestinal absorption of cholesterol and bile acids. J Lipid Res. 1979;20(3):389–98.PubMedGoogle Scholar
  35. 35.
    Jacobson TA, Maki KC, Orringer C, Jones P, Kris-Etherton P, Sikand G, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia: part 2. J Clin Lipidol. 2015;9:S1–122. doi: 10.1016/j.jacl.2015.09.002.CrossRefPubMedGoogle Scholar
  36. 36.
    Aarnio E, Korhonen MJ, Huupponen R, Martikainen J. Cost-effectiveness of statin treatment for primary prevention in conditions of real-world adherence—estimates from the Finnish prescription register. Atherosclerosis. 2015;239:240–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Chee YJ, Chan V, Tan NC. Understanding patients’ perspective of statin therapy: can we design a better approach to the management of dyslipidaemia? A literature review. Singap Med J. 2014;55:416–21.CrossRefGoogle Scholar
  38. 38.
    Phan K, Gomez Y-H, Elbaz L, Daskalopoulou SS. Statin treatment non-adherence and discontinuation: clinical implications and potential solutions. Curr Pharm Des. 2014;20:6314–24.CrossRefPubMedGoogle Scholar
  39. 39.
    Gomez Sandoval Y-H, Braganza MV, Daskalopoulou SS. Statin discontinuation in high-risk patients: a systematic review of the evidence. Curr Pharm Des. 2011;17(33):3669–89.CrossRefPubMedGoogle Scholar
  40. 40.
    Barber MJ, Mangravite LM, Hyde CL, Chasman DI, Smith JD, McCarty CA, et al. Genome-wide association of lipid-lowering response to statins in combined study populations. PLoS ONE. 2010;5(3):e9763.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Kim K, Bolotin E, Theusch E, Huang H, Medina MW, Krauss RM. Prediction of LDL cholesterol response to statin using transcriptomic and genetic variation. Genome Biol. 2014;15(9):460.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Van Ganse E, Laforest L, Alemao E, Davies G, Gutkin S, Yin D. Lipid-modifying therapy and attainment of cholesterol goals in Europe: the Return on Expenditure Attained for Lipid Therapy (REALITY) study. Curr Med Res Opin. 2005;21(9):1389–99.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  1. 1.Department of Pharmacy PracticeBeirut Arab UniversityBeirutLebanon
  2. 2.Department of Pharmacology and TherapeuticsBeirut Arab UniversityBeirutLebanon

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