Low-Potency Statins Initiated in High-Risk Patients in a Managed Care Setting

Value-Based Care in Cardiometabolic Health May 2012, Vol 1, No 1
Wayne Kuznar

Chicago, IL—A retrospective analysis of high-risk patients in a managed care setting shows that those who were newly prescribed statin therapy were usually started at low-to-moderate doses, and approximately 50% of them had discontinued therapy within 12 months, reported Terry A. Jacobson, MD, Professor of Medicine and Director of the Office of Health Promotion and Disease Prevention, Emory University, Atlanta, GA.

Dr Jacobson and colleagues conducted a retrospective analysis of 11,473 high-risk patients who were not at their low-density lipoprotein cholesterol (LDL-C) goal at baseline and were prescribed statin therapy. The patients were identified from a longitudinal database of claims information from a large, commercially insured population in the United States. All patients had at least 1 medical claim for coronary heart disease (CHD), atherosclerotic vascular disease, or diabetes before initiating statin monotherapy and were not at the optional LDL-C goal of <70 mg/dL for high-risk patients.

Of the 11,473 patients who were included, 7028 had diabetes as their only high-risk feature, 3052 had CHD or atherosclerotic disease, and 1393 had diabetes and either CHD or atherosclerotic disease.

Some 44.7% of the patients were treated with simvastatin (Zocor) and 31.5% were treated with atorvastatin (Lipitor). Most were receiving statins, which were expected to produce LDL-C lowering of 31% to 50%.

The mean LDL-C level was 138 mg/dL before statin initiation, which fell by 24% to 101 mg/dL at the first eligible postindex date (≥4 weeks after treatment initiation).

Almost two thirds (64.9%) of patients experienced a first treatment change, with a mean time to change of 93.8 days, including 46.9% who discontinued statin treatment altogether. Of the total patients, 18% were switched to a different statin.

Of the patients who had a first treatment change, 13.6% (8.8% of the total cohort) had a second treatment change, with a mean time to change of 178.3 days.

Of the 451 patients who switched statins at the first treatment change, 139 were switched to a statin at the same potency, 187 were switched to a statin with a higher potency, and 125 were switched to a lower potency statin regimen.

Of the 123 patients who switched statins at a second treatment change, 24 patients were switched to one with the same potency, 75 were switched to a higher potency regimen, and 24 were switched to a lower potency statin regimen.

The majority of patients who had a treatment change continued to take the same statin but had the dosage increased by 1 level; only 3% who had an increase in dosage had it increased by 2 levels.

According to the study authors, the treatment patterns demonstrate the need for systemwide improvements to increase medication adherence, in addition to more patient and provider education.

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