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Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study
OBJECTIVES: To describe low-density lipoprotein (LDL) cholesterol management and lipid-lowering treatment patterns in patients with a cardiovascular (CV) event. DESIGN: Retrospective cohort study using Clinical Practice Research Datalink records linked with Hospital Episode Statistics data. SETTING:...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Open
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566621/ https://www.ncbi.nlm.nih.gov/pubmed/28495810 http://dx.doi.org/10.1136/bmjopen-2016-013851 |
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author | Danese, Mark D Gleeson, Michelle Kutikova, Lucie Griffiths, Robert I Khunti, Kamlesh Seshasai, Sreenivasa Rao Kondapally Ray, Kausik K |
author_facet | Danese, Mark D Gleeson, Michelle Kutikova, Lucie Griffiths, Robert I Khunti, Kamlesh Seshasai, Sreenivasa Rao Kondapally Ray, Kausik K |
author_sort | Danese, Mark D |
collection | PubMed |
description | OBJECTIVES: To describe low-density lipoprotein (LDL) cholesterol management and lipid-lowering treatment patterns in patients with a cardiovascular (CV) event. DESIGN: Retrospective cohort study using Clinical Practice Research Datalink records linked with Hospital Episode Statistics data. SETTING: Routine clinical practice in the UK from 2006 to 2012. PARTICIPANTS: Individuals ≥18 years were selected at their first CV-related hospitalisation (first event cohort) if they had received ≥2 lipid-lowering therapy prescriptions within 180 days beforehand. Patients were stratified into four mutually exclusive subgroups based on the presence or absence of vascular disease and of diabetes. Those with a second CV hospitalisation within 36 months were included in a separate cohort (second event cohort). PRIMARY AND SECONDARY OUTCOME MEASURES: LDL levels in the year prior to the CV event and 12 months later as well as measures of adherence to lipid-lowering therapy during the 12 months after the CV hospitalisation. RESULTS: There were 24 093 patients in the first event cohort, of whom 5274 were included in the second event cohort. Most received moderate intensity statins at baseline and 12 months. Among the four first event cohort subgroups at baseline, the proportions with an LDL of <1.8 mmol/L was similar between the two diabetic cohorts (36% to 38%) and were higher than those in the two non-diabetic cohorts (17% to 22%) and in the second event cohort (31%). An incremental 5% to 9% had an LDL below 1.8 mmol/L at 12 months, suggesting intensification of therapy. The proportion of adherent patients (medication possession ratio of≥0.8) was highest for statins, ranging from 68% to 72%. For ezetimibe, the range was 65% to 70%, and for fibrates, it was 48% to 62%. CONCLUSIONS: Despite the existence of effective therapies for lowering cholesterol, patients do not reach achievable LDL targets. |
format | Online Article Text |
id | pubmed-5566621 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BMJ Open |
record_format | MEDLINE/PubMed |
spelling | pubmed-55666212017-08-28 Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study Danese, Mark D Gleeson, Michelle Kutikova, Lucie Griffiths, Robert I Khunti, Kamlesh Seshasai, Sreenivasa Rao Kondapally Ray, Kausik K BMJ Open Health Services Research OBJECTIVES: To describe low-density lipoprotein (LDL) cholesterol management and lipid-lowering treatment patterns in patients with a cardiovascular (CV) event. DESIGN: Retrospective cohort study using Clinical Practice Research Datalink records linked with Hospital Episode Statistics data. SETTING: Routine clinical practice in the UK from 2006 to 2012. PARTICIPANTS: Individuals ≥18 years were selected at their first CV-related hospitalisation (first event cohort) if they had received ≥2 lipid-lowering therapy prescriptions within 180 days beforehand. Patients were stratified into four mutually exclusive subgroups based on the presence or absence of vascular disease and of diabetes. Those with a second CV hospitalisation within 36 months were included in a separate cohort (second event cohort). PRIMARY AND SECONDARY OUTCOME MEASURES: LDL levels in the year prior to the CV event and 12 months later as well as measures of adherence to lipid-lowering therapy during the 12 months after the CV hospitalisation. RESULTS: There were 24 093 patients in the first event cohort, of whom 5274 were included in the second event cohort. Most received moderate intensity statins at baseline and 12 months. Among the four first event cohort subgroups at baseline, the proportions with an LDL of <1.8 mmol/L was similar between the two diabetic cohorts (36% to 38%) and were higher than those in the two non-diabetic cohorts (17% to 22%) and in the second event cohort (31%). An incremental 5% to 9% had an LDL below 1.8 mmol/L at 12 months, suggesting intensification of therapy. The proportion of adherent patients (medication possession ratio of≥0.8) was highest for statins, ranging from 68% to 72%. For ezetimibe, the range was 65% to 70%, and for fibrates, it was 48% to 62%. CONCLUSIONS: Despite the existence of effective therapies for lowering cholesterol, patients do not reach achievable LDL targets. BMJ Open 2017-05-10 /pmc/articles/PMC5566621/ /pubmed/28495810 http://dx.doi.org/10.1136/bmjopen-2016-013851 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Health Services Research Danese, Mark D Gleeson, Michelle Kutikova, Lucie Griffiths, Robert I Khunti, Kamlesh Seshasai, Sreenivasa Rao Kondapally Ray, Kausik K Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study |
title | Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study |
title_full | Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study |
title_fullStr | Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study |
title_full_unstemmed | Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study |
title_short | Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study |
title_sort | management of lipid-lowering therapy in patients with cardiovascular events in the uk: a retrospective cohort study |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566621/ https://www.ncbi.nlm.nih.gov/pubmed/28495810 http://dx.doi.org/10.1136/bmjopen-2016-013851 |
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