RESUMEN
BACKGROUND: Statins substantially reduce the risk of cardiovascular disease when taken regularly. Though statins are generally well tolerated, current studies show that one-third of patients discontinue use of statins within 2 years. A qualitative approach may improve the understanding of attitudes and behaviours towards statins, the mechanisms related to discontinuation, and how they are managed in primary care. AIM: To identify factors related to statin discontinuation and approaches for long-term statin adherence. DESIGN AND SETTING: A qualitative study of German GPs' experiences with statin therapy in rural and urban settings in primary care. METHOD: Semi-structured interviews (n = 16) with purposefully recruited GPs were recorded, transcribed, and analysed using qualitative content analysis. RESULTS: Sociodemographic patient factors, the nocebo effect, patient attitudes towards primary prevention, and negative media coverage had significant impacts on statin therapy according to GPs. To overcome these barriers, GPs described useful strategies combining patient motivation and education with person-centred care. GPs used computer programs for individual risk-benefit analyses in the context of shared decision making. They encouraged patients with strong concerns or perceived side effects to continue therapy with a modified medication regimen combined with individual therapy goals. CONCLUSION: GPs should be aware of barriers to statin therapy and useful approaches to overcome them. They could be supported by guideline recommendations that are more closely aligned to primary care as well as comprehensible patient information about lipid-lowering therapy. Future studies, exploring patients' specific needs and involving them in improving adherence behaviour, are recommended.
Asunto(s)
Actitud del Personal de Salud , Enfermedades Cardiovasculares/prevención & control , Dislipidemias/tratamiento farmacológico , Médicos Generales , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Adulto , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/psicología , Toma de Decisiones , Dislipidemias/epidemiología , Femenino , Medicina General , Alemania/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Cumplimiento de la Medicación/psicología , Educación del Paciente como Asunto , Relaciones Médico-Paciente , Pautas de la Práctica en Medicina/estadística & datos numéricos , Investigación CualitativaRESUMEN
INTRODUCTION: Statin therapy is the backbone of pharmacologic therapy for low-density lipoproteins cholesterol lowering and plays a pivotal role in cardiovascular disease prevention. Statin intolerance is understood as the inability to continue using a statin to reduce individual cardiovascular risk sufficiently, due to the development of symptoms or laboratory abnormalities attributable to the initiation or dose escalation of a statin. Muscle symptoms are the most common side effects observed. Areas covered: The main aim of this article is to present a review on published definitions of statin intolerance. In addition, a brief review on clinical aspects and risk factors of statin intolerance is provided and features for a common definition for statin intolerance are suggested. Expert opinion: A definition of statin intolerance by major drug regulatory agencies is not available. In clinical studies, different definitions are chosen and results are not comparable; different medical associations do not agree on one common definition. There is an unmet need to establish a common definition of statin intolerance to ensure an appropriate clinical use of this important drug class. Further work is required to develop a consensus definition on statin intolerance that could have significant positive impact on both research and clinical management.
Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Hipercolesterolemia/tratamiento farmacológico , Enfermedades Cardiovasculares/etiología , LDL-Colesterol/sangre , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Enfermedades Musculares/inducido químicamente , Enfermedades Musculares/epidemiología , Factores de RiesgoRESUMEN
Casein-derived tripeptides isoleucine-proline-proline (Ile-Pro-Pro) and valine-proline-proline (Val-Pro-Pro) lower blood pressure (BP) in long-term clinical studies. Their acute effects on BP and vascular function, important for daily dosing scheme, were studied in a placebo-controlled double-blind crossover study using a single oral dose of a fermented milk product containing Ile-Pro-Pro and Val-Pro-Pro as well as plant sterols. Twenty-five subjects with untreated mild hypertension received in random order 250 g of study product (25 mg peptides and 2 g plant sterols) or placebo. Ambulatory BP was monitored for 8 h post-dose and arterial stiffness measured by pulse wave analysis at 2, 4, and 8 h. Blood and urine samples were analyzed for markers of the renin-angiotensin system (RAS) and endothelial function. Baseline adjusted treatment effect for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial BP was -2.1 mmHg (95% CI: -4.1 to -0.1, p = 0.045), -1.6 mmHg (95% CI: -3.1 to -0.1, p = 0.03), and -1,9 mmHg (95% CI: -3-3 to -0.4, p = 0.0093), respectively, in favor of the active treatment for 8 h post- dose. No significant differences between the treatments were seen in brachial or aortic augmentation index, pulse wave velocity, or markers of RAS. Urinary excretion of cGMP, the second messenger of endothelial nitric oxide, was higher in the active group vs. placebo (p = 0.01). The results indicate that a single dose of a fermented milk product containing Ile-Pro-Pro and Val-Pro-Pro and plant sterols acutely lowers brachial SBP and DBP in mildly hypertensive subjects.