Periodic Rosuvastatin or Atorvastatin Dosing Arrays (PRADA): Patient-Centered Practice

BACKGROUND: Non-adherence is a major obstacle with long-term daily statin therapy. OBJECTIVE: This retrospective study reviewed the medical records of patients with hyperlipidemia during an 8-year period in a private internal medicine practice. Periodic dosing was negotiated following several patients’ refusal of statin therapy because of muscle aches or cost. METHODS: The clinical impetus was patient adherence to statin therapy. Treatment was initiated by dispensing rosuvastatin or atorvastatin in a stepwise patient-directed approach (from two times/week to three times/week to every other day, up to five times/week). The primary endpoint was to assess the concentration of low-density lipoprotein cholesterol (LDL-C) and the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio with patient-directed dosing intervals. The secondary endpoint was a head-to-head comparison of atorvastatin and rosuvastatin to evaluate the mean decrease in the LDL-C and TC/HDL-C ratio. RESULTS: Chart review identified 46 patients who had been treated. Two patients with persistent myalgia terminated treatment before 12 weeks. Among the remaining 44 patients, 20 received doses of rosuvastatin from 15 to 100 mg per week, and 24 received atorvastatin from 20 to 140 mg per week. There was a significant decrease from pre-treatment in the mean TC/HDL-C ratio of 1.72 (31.1 %, P < 0.0001) and mean LDL-C of 43.3 mg/dL (30.2 %, P < 0.0001). An independent samples t-test showed a non-significant reduction of the mean TC/HDL-C ratio and LDL-C with rosuvastatin versus atorvastatin. CONCLUSION: Periodic dosing of rosuvastatin or atorvastatin using a gradual, patient-directed, stepwise approach guided by cholesterol levels is an effective method of lipid lowering and carried a favorable 95.6 % adherence rate.