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 78
- Downloads 0
α1-Adrenergic receptor subtypes in the central nervous system: insights from genetically engineered mouse models.
α1-Adrenergic receptors (α1-ARs) are important players in peripheral and central nervous system (CNS) regulation and function and in mediating various behavioral responses. The α1-AR family consists of three subtypes, α1...
Profile of anticonvulsant activity and neuroprotective effects of novel and potential antiepileptic drugs - an update.
Although neuroprotection is effective only against certain aspects of a complex cascade of pathological events during the development and course of epilepsy, it might be a promising option in the treatment of this diseas...
Gestational manganese intoxication and anxiolytic-like effects of diazepam and the 5-HT1A receptor agonist 8-OH-DPAT in male Wistar rats.
In the present study, the effects of prenatal manganese (Mn) intoxication on the anxiolytic-like effects of diazepam and the 5-HT(1A) receptor agonist R-(+)-8-hydroxy-dipropylaminotetralin (8-OH-DPAT) were examined.Wista...
Effect of two behavioral tests on corticosterone level in plasma of mice lacking the noradrenaline transporter.
In the present study, we investigated plasma corticosterone levels of genetically modified mice lacking noradrenaline transporter (NET(-/-)), in response to the forced swim test (FST) and tail suspension test (TST). FST...
Administration of L-carnitine and mildronate improves endothelial function and decreases mortality in hypertensive Dahl rats.
Hypertension is a well established risk factor for the development of cardiovascular diseases and increased mortality. This study was performed to investigate the effects of the administration of L-carnitine or mildronat...