RESUMEN
BACKGROUND: In the advent of generic statins becoming increasingly available and with the recent addition of atorvastatin to the generic market, healthcare providers are often encouraged by payers to switch from a branded statin to an alternate, less costly agent. OBJECTIVE: The aim of this study was to determine the impact of a therapeutic switch on cholesterol goal attainment among patients with existing cardiovascular disease (CVD) or risk factors for CVD. STUDY DESIGN: A cross-sectional, multisite retrospective review of patient records evaluating low-density lipoprotein cholesterol (LDL-C) control before and after switching statins was conducted. METHODS: Participants were 18 to 89 years olds who were stable on statin therapy and had 1 or more risk factors for CVD. Patients meeting switch criteria (n = 833) were evaluated for changes in their statin therapy and LDL-C goal attainment. Drug/dose information, cholesterol values, and goal attainment in accordance with National Cholesterol Education Panel Third Adult Treatment Panel guidelines were determined before and after the switch. Dose potency was based on mean LDL-C reductions. RESULTS: Data were collected from 22 US sites. Risk factors for CVD were common, with 88.5% of patients identified as high risk. Overall, patients' mean LDL-C levels improved from 87.1 to 81.5 mg/dL, and goal attainment increased from 75.5% to 82.5% (P < .05). Switches to a comparable or higher statin/dose improved mean LDL-C and goal attainment (P < .05). However, in patients transitioned to a lower statin/dose equivalency (36.4%), mean LDL-C level increased from 79.8 to 85.6 mg/dL and goal attainment fell from 84.2% to 78.6% (P < .05). Logistic regression confirmed that LDL-C goal attainment was reduced by 53% in patients switched to a lower statin/dose (odds ratio, 0.47; 95% confidence interval, 0.30-0.76; P = .002) compared with patients switched to an equipotent dose. The use of adjunctive lipid-lowering therapies increased in patients switched to a lower statin/dose (P < .05). CONCLUSIONS: Cholesterol values and goal attainment can be negatively impacted when a systematic approach is not used and patients are switched to lower potency therapies.
Asunto(s)
LDL-Colesterol/sangre , Sustitución de Medicamentos/normas , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Estudios Transversales , Humanos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To describe the results of an initiative to create awareness of coronary heart disease and provide education regarding cardiovascular (CV) risk and cholesterol (lipid) management in a community-based senior population. A multidisciplinary partnership composed of governmental agencies, a member of the pharmaceutical industry, a college of pharmacy, and several community-based health care practitioners collaborated in the program. DESIGN: Prospective CV risk assessment, educational interventions, and follow-up. SETTING: Community centers providing wellness and activity programs for ambulatory seniors. PATIENTS: Ambulatory senior adults who were active participants in senior center programs were invited to participate in a series of health screenngs at a center-based health fair. Those who met specific evidence-based qualifying criteria were enrolled in the program. MAIN OUTCOME MEASURES: Changes in CV risk profile, specifically, total cholesterol, low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), triglycerides (TG), blood glucose levels; and attainment of National Cholesterol Education Program (NCEP) lipid goals of the Adult Treatment Panel III. RESULTS: Initial screening of 501 patients for eligibility allowed 273 patients to qualify and enroll in the program. A total of 112 (41.0%) participants returned for the year 2 follow-up, leaving a loss to follow-up of 161 patients. Compared with baseline, reductions occurred in total cholesterol (206.8 mg/dL vs.182.9 mg/dL), LDL-C (122.2 mg/dL vs. 105.5 mg/dL), HDL-C (51.5 mg/dL vs. 49.6 mg/dL), TG (164.8 mg/dL vs. 136.4 mg/dL), and blood glucose (115 mg/dL vs. 106.3 mg/dL); the number of patients with less than two risk factors decreased from 43 (38.4%) to 28 (25.0%) and those with two or more risk factors increased from 69 (61.6%) to 84 (75.0%); the number of patients at NCEP (lipid) goal increased from 57 (50.9%) to 80 (71.4%). CONCLUSION: For senior adults participating in the program, improvements occurred in both the lipid profiles and the number of patients at their NCEP (lipid) goal, although the number of seniors with > or = two risk factors increased from 69 (61.6%) to 84 (75.0%). A multidisciplinary partnership for improving the CV health and awareness of an ambulatory senior population is a unique opportunity for pharmacists to provide wellness services for seniors.