ABSTRACT
BACKGROUND: The burden of cardiovascular (CV) disease remains high despite substantial improvements in low-density lipoprotein cholesterol (LDL-C) goal achievement rates. METHODS AND RESULTS: Two cohorts of mixed dyslipidaemia patients were identified from the HealthCore Integrated Research Database. Patients with no baseline lipids [LDL-C, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C)] at optimal values (n=27,094) and patients at LDL-C goal but with at least one other lipid not at optimal value at baseline (n=83,067) were followed for approximately 2 years. The primary outcome was the association between achievement of optimal lipid values (OLV) and occurrence of ischaemic heart disease, cerebrovascular disease or peripheral arterial disease. Achievement of OLV during follow up occurred in 6.8% of patients with no baseline lipids at optimal values and in 17.9% of patients at LDL-C goal with at least one other lipid not at optimal value at baseline. After adjustment, significant reductions in CV events were associated with achievement of OLV across the entire lipid panel in patients who had no optimal baseline lipid values (hazard ratio, 0.407; 95% confidence interval, 0.303-0.546) or when patients were at LDL-C goals at baseline (hazard ratio, 0.764; 95% confidence interval, 0.703-0.831). CONCLUSIONS: In conclusion, challenges to effective treatment of mixed dyslipidaemia remain, as evidenced by a minority of patients achieving optimal lipid levels. There appears to be an association with incremental lowering of CV event rates beyond LDL-C goal attainment when compared with achieving OLV across the entire lipid panel for LDL-C, TG and HDL-C.
Subject(s)
Dyslipidemias/blood , Lipids/blood , Aged , Cerebrovascular Disorders/blood , Cerebrovascular Disorders/etiology , Cholesterol, HDL/metabolism , Cholesterol, LDL/metabolism , Dyslipidemias/complications , Dyslipidemias/therapy , Female , Humans , Kaplan-Meier Estimate , Longitudinal Studies , Male , Middle Aged , Myocardial Ischemia/blood , Myocardial Ischemia/etiology , Peripheral Arterial Disease/blood , Peripheral Arterial Disease/etiology , Retrospective Studies , Risk Factors , Triglycerides/metabolismABSTRACT
BACKGROUND: The introduction of a generic formulation of simvastatin has created the potential to provide significant low-density lipoprotein cholesterol (LDL-C) reduction in a highly cost-effective manner. METHODS: This retrospective cohort analysis utilised electronic medical record data from a United States, community-based, independent physician family medicine practice. Patients switched from other statins or statin combinations to simvastatin by the family medicine physicians during routine patient care from January 2002 to October 2008 were identified. Equivalent statin dosing, lipid panel changes and National Cholesterol Education Program--Adult Treatment Panel III (NCEP) LDL-C goal attainment rates were compared preswitch and postswitch. The potential economic impact of simvastatin switching was also evaluated. RESULTS: A total of 78 patients were identified, and in 76.9% of the switches, an equipotent dose of simvastatin was prescribed. All lipid fractions showed small, non-significant increases, with LDL-C having a 2.2 mg/dl (0.06 mmol/l) increase after switching (p = 0.476). NCEP LDL-C goal attainment rates were 79.5% and 78.2% before and after switching, respectively (p = 1.00). Modelled annual cost savings associated with switching were estimated at $671.99 per patient. CONCLUSIONS: These results demonstrate that an independent family medicine physician practice can successfully perform statin therapeutic substitution during routine patient care. Equivalent clinical outcomes with regards to changes in lipid fractions and NCEP LDL-C goal attainment were observed in conjunction with the potential for reduced costs for patients.
