Effectiveness of lipid-lowering therapy with statins for secondary prevention of atherosclerosis - guidelines vs. reality.
Journal Title: Pharmacological Reports - Year 2012, Vol 64, Issue 2
Abstract
Background: The aim of the study was to analyze the effectiveness of lipid-lowering therapy and therapeutic decisions made by physicians for patients not achieving LDL targets. Methods: 11,768 patients undergoing therapy with statins for secondary prevention of atherosclerosis participated in a two-visit survey. In subjects not achieving the LDL-target (< 100 mg/dl), further therapeutic decisions made by physicians were recorded. Results: Initially the LDL-target was achieved by 7.8% of patients on simvastatin and by 18.0% on atorvastatin, of which 20.8% were treated with at least a 40 mg dose. The most common changes in therapy to improve effectiveness was substituting simvastatin for another statin (75.2%, usually atorvastatin), or increasing atorvastatin dosage (59.8%). Intensification of a low fat diet and weight reduction were more frequently recommended in treatment with atorvastatin than with simvastatin (59.8% vs. 55.9%, p < 0.001). After enhanced therapy, the LDL-target was achieved by 27.8% on simvastatin and by 35.0% on atorvastatin (p < 0.001). In those with LDL levels remaining above the target, substitution of simvastatin with atorvastatin (49.9%), or the increase of atorvastatin dose (41.4%) was recommended. As previously, life-style counseling was more frequent in patients on atorvastatin (66.1% vs. 45.7% p < 0.001). Conclusions: 1. The use of low dose statins and noncompliance with behavioral modification guidelines are responsible for the low levels of effectiveness found with lipid-lowering therapies. 2. Physicians prefer substitution of less effective statins over the increase of dose in patients not achieving LDL targets. 3. Life-style changes are under-prescribed by physicians and under-implemented by their patients.
Authors and Affiliations
Maria Bożentowicz-Wikarek, Piotr Kocełak, Mike Smertka, Magdalena Olszanecka-Glinianowicz, Jerzy Chudek
Keywords
Related Articles
- EP ID EP103414
- DOI -
- Views 70
- Downloads 0
Extralipid effects of micronized fenofibrate in dyslipidemic patients.
The aim of this study was to evaluate the levels of lipid and extralipid parameters in patients with atherogenic dyslipidemia. We investigated the lipid-lowering therapeutic efficacy of fenofibrate and its extralipid inf...
Involvement of kainate receptors in the analgesic but not hypnotic effects induced by inhalation anesthetics.
In the present study, the role of kainate (KA) receptors in hypnosis and analgesia induced by emulsified inhalation anesthetics was investigated. A mouse model of hypnosis and analgesia was established by an intraperiton...
Interactions between drugs and sulforaphane modulate the drug metabolism enzymatic system.
Background: Sulforaphane (SFN) is a potent chemopreventive agent, which is widely consumed in diet or as a diet supplement. It modulates the enzymes of II and III metabolism phase. In this paper, the influence of SFN and...
Up-regulation of vascular cyclooxygenase-2 in diabetes mellitus.
Diabetes mellitus is associated with disturbed regulation in the microcirculation. A low-grade vascular inflammation has been implicated in the development of diabetes-related vascular complications, but the underlying m...
Effects of baclofen and L-AP4 in passive avoidance test in rats after hypoxia-induced amnesia.
Hypoxia-induced cognitive deficits are mainly due to disturbances of the balance between the GABAergic and glutamatergic systems. Acquisition, consolidation and retention impairment in passive avoidance test, hypolocomot...