Back to Search
Start Over
LDL-cholesterol change and goal attainment following statin intensity titration among Asians in primary care: a retrospective cohort study
- Source :
- Lipids in Health and Disease, Lipids in Health and Disease, Vol 20, Iss 1, Pp 1-10 (2021)
- Publication Year :
- 2021
- Publisher :
- Springer Science and Business Media LLC, 2021.
-
Abstract
- Background Clinical trials have demonstrated that either initiating or up-titrating a statin dose substantially reduce Low-Density Lipoprotein-Cholesterol (LDL-C) levels. However, statin adherence in actual practice tends to be suboptimal, leading to diminished effectiveness. This study aims to use real-world data to determine the effect on LDL-C levels and LDL-C goal attainment rates, when selected statins are titrated in Asian patients. Methods A retrospective cohort study over a 5-year period, from April 2014 to March 2019 was conducted on a cohort of multi-ethnic adult Asian patients with clinical diagnosis of Dyslipidaemia in a primary care clinic in Singapore. The statins were classified into low-intensity (LI), moderate-intensity (MI) and high-intensity (HI) groups according to the 2018 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guidelines. Patients were grouped into “No statin”, “Non-titrators” and “Titrators” cohorts based on prescribing patterns. For the “Titrators” cohort, the mean percentage change in LDL-C and absolute change in LDL-C goal attainment rates were computed for each permutation of statin intensity titration. Results Among the cohort of 11,499 patients, with a total of 266,762 visits, there were 1962 pairs of LDL-C values associated with a statin titration. Initiation of LI, MI and HI statin resulted in a lowering of LDL-C by 21.6% (95%CI = 18.9–24.3%), 28.9% (95%CI = 25.0–32.7%) and 25.2% (95%CI = 12.8–37.7%) respectively. These were comparatively lower than results from clinical trials (30 to 63%). The change of LDL-C levels due to up-titration, down-titration, and discontinuation were − 12.4% to − 28.9%, + 13.2% to + 24.6%, and + 18.1% to + 32.1% respectively. The improvement in LDL-C goal attainment ranged from 26.5% to 47.1% when statin intensity was up-titrated. Conclusion In this study based on real-world data of Asian patients in primary care, it was shown that although statin titration substantially affected LDL-C levels and LDL-C goal attainment rates, the magnitude was lower than results reported from clinical trials. These results should be taken into consideration and provide further insight to clinicians when making statin adjustment recommendations in order to achieve LDL-C targets in clinical practice, particularly for Asian populations.
- Subjects :
- Male
medicine.medical_specialty
Statin
Clinical chemistry
medicine.drug_class
Endocrinology, Diabetes and Metabolism
Clinical Biochemistry
Clinical nutrition
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Endocrinology
Asian People
Risk Factors
Internal medicine
Odds Ratio
medicine
Humans
LDL-cholesterol
030212 general & internal medicine
lcsh:RC620-627
Aged
Retrospective Studies
Primary Health Care
Asian
business.industry
Research
Biochemistry (medical)
Percentage change
Retrospective cohort study
Cholesterol, LDL
Middle Aged
Goal attainment
Primary care
Real-world data
Intensity (physics)
Discontinuation
Clinical trial
lcsh:Nutritional diseases. Deficiency diseases
Treatment Outcome
Cohort
Female
lipids (amino acids, peptides, and proteins)
Hydroxymethylglutaryl-CoA Reductase Inhibitors
business
Goals
Subjects
Details
- ISSN :
- 1476511X
- Volume :
- 20
- Database :
- OpenAIRE
- Journal :
- Lipids in Health and Disease
- Accession number :
- edsair.doi.dedup.....894e503cd84bcf1137a65a5cb8585922