Cardiovasc Prev Pharmacother.  2020 Jul;2(3):103-111. 10.36011/cpp.2020.2.e14.

Changes in Target Achievement Rates after Statin Prescription Changes at a Single University Hospital

Affiliations
  • 1Division of Biomedical Informatics, Systems Biomedical Informatics Research Center, Seoul National University College of Medicine, Seoul, Korea
  • 2Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Background
We investigated the changes in low-density lipoprotein cholesterol (LDL-C) target achievement rates (<70 and <100 mg/dL) when the prescription changed from various statins to Lipilou®, a generic formulation of atorvastatin.
Methods
This was a retrospective cohort study of patients who had been prescribed Lipilou® for more than 3 months at Seoul National University Hospital from 2012 to 2018. For patients who were treated with a previous statin before the prescription of Lipilou®, changes in target achievement rates of LDL-C less than 70 and less than 100 mg/dL were confirmed 3–6 months after the prescription of Lipilou®.
Results
Among the 683 enrolled patients, when their prescription was changed to Lipilou®, the target achievement rate of LDL-C significantly increased for LDL-C less than 70 mg/dL (from 22.1% to 66.2%, p<0.001) and less than 100 mg/dL (from 26.8% to 75.3%, p<0.001). In particular, when a moderate-low potency statin was changed to Lipilou® (10 mg), the target achievement rates for LDL-C less than 70 mg/dL (from 28.9% to 66.7%, p<0.001) and less than 100 mg/dL (from 42.2% to 86.7%, p<0.001) significantly increased. The change from a moderate-high potency statin to Lipilou® (20 mg) showed an increased target achievement rates for LDL-C <70 mg/dL (from 33.3% to 80.0%, p=0.008) and 100 mg/dL (from 40.0% to 73.3%, p<0.025).
Conclusions
We cannot simply conclude that Lipilou® is superior to other statins. However, when the target LDL-C was not reached with previous statin treatments, a high target achievement rate could be achieved by changing the prescription to Lipilou®. Physicians should always consider aggressive statin prescription changes for high target achievement rates.

Keyword

Atorvastatin; Cardiovascular diseases; Cholesterol; Dyslipidemia; Electronic health records

Figure

  • Figure 1. Flow chart describing the process of patient enrollment. Among the 3,991 patients who had a prescription history of Lipilou®, 683 patients who met the criteria have been enrolled.LDL-C = low density lipoprotein cholesterol; SNUH = Seoul National University Hospital.


Reference

1. World Health Organization; World Heart Federation; World Stroke Organization. Global Atlas on Cardiovascular Disease Prevention and Control: Policies, Strategies and Interventions. Geneva: World Health Organization;2011.
2. World Health Organization. Cardiovascular diseases [Internet]. Geneva: World Health Organization;2020. [cited 2020 May 23]. Available from: https://www.who.int/health-topics/cardiovascular-diseases.
3. World Health Organization. Hearts: technical package for cardiovascular disease management in primary health care [Internet]. Geneva: World Health Organization;2016. [cited 2020 May 23]. Available from: https://www.who.int/health-topics/cardiovascular-diseases.
4. Roth GA, Fihn SD, Mokdad AH, Aekplakorn W, Hasegawa T, Lim SS. High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries. Bull World Health Organ. 2011; 89:92–101.
Article
5. Anderson TJ, Mancini GB, Genest J Jr, Grégoire J, Lonn EM, Hegele RA. The new dyslipidemia guidelines: what is the debate? Can J Cardiol. 2015; 31:605–12.
Article
6. Kim HC. Epidemiology of dyslipidemia in Korea. J Korean Med Assoc. 2016; 59:352–7.
Article
7. European Association for Cardiovascular Prevention & Rehabilitation, Reiner ZCatapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, Agewall S, Alegria E, Chapman MJ, Durrington P, Erdine S, Halcox J, Hobbs R, Kjekshus J, Filardi PP, Riccardi G, Storey RF, Wood D; ESC Committee for Practice Guidelines (CPG) 2008-2010 and 2010-2012 Committees. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J. 2011; 32:1769–818.
8. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63 25 Pt B:2935–59.
9. Franco OH, Peeters A, Looman CW, Bonneux L. Cost effectiveness of statins in coronary heart disease. J Epidemiol Community Health. 2005; 59:927–33.
Article
10. Ward S, Lloyd Jones M, Pandor A, Holmes M, Ara R, Ryan A, Yeo W, Payne N. A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess. 2007; 11:1–160.
Article
11. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WM, Vlachopoulos C, Wood DA, Zamorano JL. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis. 2016; 253:281–344.
Article
12. Jellinger PS. American Association of Clinical Endocrinologists/American College of Endocrinology Management of Dyslipidemia and Prevention of Cardiovascular Disease Clinical Practice Guidelines. Diabetes Spectr. 2018; 31:234–45.
Article
13. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O, Mueller C, Drexel H, Aboyans V, Corsini A, Doehner W, Farnier M, Gigante B, Kayikcioglu M, Krstacic G, Lambrinou E, Lewis BS, Masip J, Moulin P, Petersen S, Petronio AS, Piepoli MF, Pintó X, Räber L, Ray KK, Reiner Ž, Riesen WF, Roffi M, Schmid JP, Shlyakhto E, Simpson IA, Stroes E, Sudano I, Tselepis AD, Viigimaa M, Vindis C, Vonbank A, Vrablik M, Vrsalovic M, Zamorano JL, Collet JP, Koskinas KC, Casula M, Badimon L, John Chapman M, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O, Windecker S, Aboyans V, Baigent C, Collet JP, Dean V, Delgado V, Fitzsimons D, Gale CP, Grobbee D, Halvorsen S, Hindricks G, Iung B, Jüni P, Katus HA, Landmesser U, Leclercq C, Lettino M, Lewis BS, Merkely B, Mueller C, Petersen S, Petronio AS, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Touyz RM, Nibouche D, Zelveian PH, Siostrzonek P, Najafov R, van de Borne P, Pojskic B, Postadzhiyan A, Kypris L, Špinar J, Larsen ML, Eldin HS, Viigimaa M, Strandberg TE, Ferrières J, Agladze R, Laufs U, Rallidis L, Bajnok L, Gudjónsson T, Maher V, Henkin Y, Gulizia MM, Mussagaliyeva A, Bajraktari G, Kerimkulova A, Latkovskis G, Hamoui O, Slapikas R, Visser L, Dingli P, Ivanov V, Boskovic A, Nazzi M, Visseren F, Mitevska I, Retterstøl K, Jankowski P, Fontes-Carvalho R, Gaita D, Ezhov M, Foscoli M, Giga V, Pella D, Fras Z, de Isla LP, Hagström E, Lehmann R, Abid L, Ozdogan O, Mitchenko O, Patel RS; ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020; 41:111–88.
Article
14. Chan JC, Kong AP, Bao W, Fayyad R, Laskey R. Safety of atorvastatin in Asian patients within clinical trials. Cardiovasc Ther. 2016; 34:431–40.
Article
15. Kim HS, Kim H, Lee H, Park B, Park S, Lee SH, Cho JH, Song H, Kim JH, Yoon KH, Choi IY. Analysis and comparison of statin prescription patterns and outcomes according to clinical department. J Clin Pharm Ther. 2016; 41:70–7.
Article
16. Kajinami K, Takekoshi N, Matsui S, Kanemitsu S, Okubo S, Kanayama S, Yamashita N, Sato R. Effect of pretreatment vitamin D levels on in vivo effects of atorvastatin on bone metabolism in patients with heterozygous familial hypercholesterolemia. Am J Cardiol. 2003; 92:1113–6.
Article
17. Mukhtar RY, Reid J, Reckless JP. Pitavastatin. Int J Clin Pract. 2005; 59:239–52.
Article
18. Diabetes Canada Clinical Practice Guidelines Expert Committee, Mancini GBJ, Hegele RA, Leiter LA. Dyslipidemia. Can J Diabetes. 2018; 42 Suppl 1:S178–85.
Article
19. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R; 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; 366:1267–78.
Article
20. Zhang D, Ge L, Li J, Li X, Feng F, Chen YP, Chen ZM, Martin L, Jane A, Chen F, Jiang LX; HPS2-THRIVE Collaborative Group. Current statin use for patients with atherosclerotic cardiovascular disease in 39 large Chinese hospitals. Zhonghua Xin Xue Guan Bing Za Zhi. 2011; 39:397–401.
21. Lin YC, Yang CC, Chen YJ, Peng WC, Li CY, Hwu CM. Utilization of statins and aspirin among patients with diabetes and hyperlipidemia: Taiwan, 1998-2006. J Chin Med Assoc. 2012; 75:567–72.
Article
22. Korean Society of Lipid and Atherosclerosis. Dyslipidemia fact sheets in Korea 2018 [Internet]. Seoul: Korean Society of Lipid and Atherosclerosis;2018. [cited 2020 May 23]. Available from: https://www.lipid.or.kr/file/Dyslipidemia%20Fact%20Sheets%20in%20Korea%202018.pdf.
23. Kim SH, Park K, Hong SJ, Cho YS, Sung JD, Moon GW, Yoon MH, Lee MY, Hyon MS, Kim DW, Kim HS. Efficacy and tolerability of a generic and a branded formulation of atorvastatin 20 mg/d in hypercholesterolemic Korean adults at high risk for cardiovascular disease: a multicenter, prospective, randomized, double-blind, double-dummy clinical trial. Clin Ther. 2010; 32:1896–905.
Article
24. Hong SJ, Choi SY, Han SH, Choi YJ, Ahn T. Safety and tolerability of atorvastatin calcium anhydrous in Korean patients with dyslipidemia: an interim analysis from the lamp study. Atherosclerosis. 2017; 263:e236.
Article
25. Kim HS, Lee SH, Kim H, Lee SH, Cho JH, Lee H, Yim HW, Kim SH, Choi IY, Yoon KH, Kim JH. Statinrelated aminotransferase elevation according to baseline aminotransferases level in real practice in Korea. J Clin Pharm Ther. 2016; 41:266–72.
Article
26. Kim HS, Lee S, Kim JH. Real-world evidence versus randomized controlled trial: clinical research based on electronic medical records. J Korean Med Sci. 2018; 33:e213.
Article
27. Kim HS, Kim JH. Proceed with caution when using real world data and real world evidence. J Korean Med Sci. 2019; 34:e28.
Article
Full Text Links
  • CPP
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr