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Original article

Vol. 150 No. 2122 (2020)

Statin treatment and LDL target value achievement in Swiss general practice – a retrospective observational study

  • Yael Rachamin
  • Rahel Meier
  • Thomas Rosemann
  • Stefan Langenegger
  • Stefan Markun
DOI
https://doi.org/10.4414/smw.2020.20244
Cite this as:
Swiss Med Wkly. 2020;150:w20244
Published
27.05.2020

Summary

AIMS

Statins decrease the risk of fatal CVD by lowering low-density lipoprotein (LDL) levels. Guidelines suggest that statin treatment strategies should be guided by CV risk, but little is known about statin treatment in Swiss general practice. In this study, we aimed to investigate statin treatment and LDL target achievement rates, including their predictors, in patients treated by Swiss general practitioners (GPs).

METHODS

Retrospective observational study of statin-treated patients in 2018 using a general practice electronic medical records database. CV risk categories were defined according to the ESC guidelines published in 2016. We used multilevel logistic regression models to find associations between patient and GP demographic factors and LDL target achievement.

RESULTS

We analysed 11,779 statin-treated patients, of whom 59% were at a high or very high risk of fatal CVD. High-intensity statin treatment was used in 39% of patients, and LDL measurement was performed at least once in 54% of patients. Achievement of LDL target levels across CV risk categories was 36% in very high-risk, 56% in high-risk, and 66% in low-/moderate-risk patients, and generally higher for male patients.

CONCLUSIONS

Although over half of patients were at a high or very high risk of fatal CVD, the majority did not receive high-intensity statin treatment. Only a third of very high-risk patients achieved LDL target values, and there was a gender gap in LDL target achievement disadvantaging female patients. Results from this study suggest that current treatment may warrant reconsideration in a large proportion of patients treated with statins in Swiss general practice.

References

  1. Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al.; GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736–88. doi:.https://doi.org/10.1016/S0140-6736(18)32203-7
  2. Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459–72. doi:.https://doi.org/10.1093/eurheartj/ehx144
  3. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, et al., Cholesterol Treatment Trialists’ (CTT) Collaborators. 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. doi:.https://doi.org/10.1016/S0140-6736(05)67394-1
  4. Tramacere I, Boncoraglio GB, Banzi R, Del Giovane C, Kwag KH, Squizzato A, et al. Comparison of statins for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis. BMC Med. 2019;17(1):67. doi:.https://doi.org/10.1186/s12916-019-1298-5
  5. Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;(1):CD004816. doi:.https://doi.org/10.1002/14651858.CD004816.pub5
  6. Ward S, Lloyd Jones M, Pandor A, Holmes M, Ara R, Ryan A, et al. A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess. 2007;11(14):1–160, iii–iv. doi:.https://doi.org/10.3310/hta11140
  7. Vrecer M, Turk S, Drinovec J, Mrhar A. Use of statins in primary and secondary prevention of coronary heart disease and ischemic stroke. Meta-analysis of randomized trials. Int J Clin Pharmacol Ther. 2003;41(12):567–77. doi:.https://doi.org/10.5414/CPP41567
  8. Byrne P, Cullinan J, Smith A, Smith SM. Statins for the primary prevention of cardiovascular disease: an overview of systematic reviews. BMJ Open. 2019;9(4):e023085. doi:.https://doi.org/10.1136/bmjopen-2018-023085
  9. Damen JA, Hooft L, Schuit E, Debray TP, Collins GS, Tzoulaki I, et al. Prediction models for cardiovascular disease risk in the general population: systematic review. BMJ. 2016;353:i2416. doi:.https://doi.org/10.1136/bmj.i2416
  10. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al.; ESC Scientific Document Group. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016;37(39):2999–3058. doi:.https://doi.org/10.1093/eurheartj/ehw272
  11. Shepherd J. Resource management in prevention of coronary heart disease: optimising prescription of lipid-lowering drugs. Lancet. 2002;359(9325):2271–3. doi:.https://doi.org/10.1016/S0140-6736(02)09299-1
  12. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al.; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25, 25 Pt B):2889–934. doi:. Correction in: J Am Coll Cardiol. 2014;63(25, 25 Pt B):3024–5 https://doi.org/10.1016/j.jacc.2013.11.002
  13. Chmiel C, Bhend H, Senn O, Zoller M, Rosemann T ; FIRE study-group. The FIRE project: a milestone for research in primary care in Switzerland. Swiss Med Wkly. 2011;140:w13142.
  14. R Core Team. R: A language and environment for statistical computing. In: Computing RFfS, editor. Vienna, Austria2018.
  15. Swiss Atherosclerosis Association (AGLA). Available from: https://www.agla.ch/.
  16. Danese MD, Sidelnikov E, Kutikova L. The prevalence, low-density lipoprotein cholesterol levels, and treatment of patients at very high risk of cardiovascular events in the United Kingdom: a cross-sectional study. Curr Med Res Opin. 2018;34(8):1441–7. doi:.https://doi.org/10.1080/03007995.2018.1463211
  17. Rodriguez F, Maron DJ, Knowles JW, Virani SS, Lin S, Heidenreich PA. Association Between Intensity of Statin Therapy and Mortality in Patients With Atherosclerotic Cardiovascular Disease. JAMA Cardiol. 2017;2(1):47–54. doi:.https://doi.org/10.1001/jamacardio.2016.4052
  18. Yang Z, Edwards D, Massou E, Saunders CL, Brayne C, Mant J. Statin use and high-dose statin use after ischemic stroke in the UK: a retrospective cohort study. Clin Epidemiol. 2019;11:495–508. doi:.https://doi.org/10.2147/CLEP.S201983
  19. Zhang H, Plutzky J, Skentzos S, Morrison F, Mar P, Shubina M, et al. Discontinuation of statins in routine care settings: a cohort study. Ann Intern Med. 2013;158(7):526–34. doi:.https://doi.org/10.7326/0003-4819-158-7-201304020-00004
  20. Deshpande S, Quek RGW, Forbes CA, de Kock S, Kleijnen J, Gandra SR, et al. A systematic review to assess adherence and persistence with statins. Curr Med Res Opin. 2017;33(4):769–78. doi:.https://doi.org/10.1080/03007995.2017.1281109
  21. Presta V, Figliuzzi I, Miceli F, Coluccia R, Fogacci F, Cicero AFG, et al.; EFFECTUS Steering Committee. Achievement of low density lipoprotein (LDL) cholesterol targets in primary and secondary prevention: Analysis of a large real practice database in Italy. Atherosclerosis. 2019;285:40–8. doi:.https://doi.org/10.1016/j.atherosclerosis.2019.03.017
  22. Arca M, Ansell D, Averna M, Fanelli F, Gorcyca K, Iorga SR, et al. Statin utilization and lipid goal attainment in high or very-high cardiovascular risk patients: Insights from Italian general practice. Atherosclerosis. 2018;271:120–7. doi:.https://doi.org/10.1016/j.atherosclerosis.2018.02.024
  23. Ferrières J, Gorcyca K, Iorga ŞR, Ansell D, Steen DL. Lipid-lowering Therapy and Goal Achievement in High-risk Patients From French General Practice. Clin Ther. 2018;40(9):1484–1495.e22. doi:.https://doi.org/10.1016/j.clinthera.2018.07.008
  24. März W, Dippel F-W, Theobald K, Gorcyca K, Iorga ŞR, Ansell D. Utilization of lipid-modifying therapy and low-density lipoprotein cholesterol goal attainment in patients at high and very-high cardiovascular risk: Real-world evidence from Germany. Atherosclerosis. 2018;268:99–107. doi:.https://doi.org/10.1016/j.atherosclerosis.2017.11.020
  25. Rodriguez F, Olufade TO, Ramey DR, Friedman HS, Navaratnam P, Heithoff K, et al. Gender Disparities in Lipid-Lowering Therapy in Cardiovascular Disease: Insights from a Managed Care Population. J Womens Health (Larchmt). 2016;25(7):697–706. doi:.https://doi.org/10.1089/jwh.2015.5282
  26. Santos RD, Waters DD, Tarasenko L, Messig M, Jukema JW, Ferrières J, et al.; L-TAP 2 Investigators. Low- and high-density lipoprotein cholesterol goal attainment in dyslipidemic women: The Lipid Treatment Assessment Project (L-TAP) 2. Am Heart J. 2009;158(5):860–6. doi:.https://doi.org/10.1016/j.ahj.2009.08.009
  27. Moreno-Arellano S, Delgado-de-Mendoza J, Santi-Cano MJ. Sex disparity persists in the prevention of cardiovascular disease in women on statin therapy compared to that in men. Nutr Metab Cardiovasc Dis. 2018;28(8):810–5. doi:.https://doi.org/10.1016/j.numecd.2018.03.012
  28. Schoen MW, Tabak RG, Salas J, Scherrer JF, Buckhold FR. Comparison of Adherence to Guideline-Based Cholesterol Treatment Goals in Men Versus Women. Am J Cardiol. 2016;117(1):48–53. doi:.https://doi.org/10.1016/j.amjcard.2015.10.007
  29. Fulcher J, O’Connell R, Voysey M, Emberson J, Blackwell L, Mihaylova B, et al., Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet. 2015;385(9976):1397–405. doi:.https://doi.org/10.1016/S0140-6736(14)61368-4
  30. Bairey Merz CN, Andersen H, Sprague E, Burns A, Keida M, Walsh MN, et al. Knowledge, Attitudes, and Beliefs Regarding Cardiovascular Disease in Women: The Women’s Heart Alliance. J Am Coll Cardiol. 2017;70(2):123–32. doi:. Correction in: J Am Coll Cardiol. 2017;70(8)https://doi.org/10.1016/j.jacc.2017.05.024

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