An expert opinion paper on statin adherence and implementation of new lipid-lowering medications by the ESC Working Group on Cardiovascular Pharmacotherapy: Barriers to be overcome

Drexel, Heinz; Coats, Andrew J.S.; Spoletini, Ilaria; Bilato, Claudio; Mollace, Vincenzo; Filardi, Pasquale Perrone; Rosano, Giuseppe

doi:10.1093/ehjcvp/pvz079

Cited by 53 publications

(36 citation statements)

References 60 publications

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“…Furthermore, while current guidance specifies situations where specialist support should be sought, there is presently no specific definition of a "specialist" within the guidelines. 9 The subsequent interpretation of this guidance and associated referral processes Table 2 Possible Strategies to Improve Adherence with Cholesterol Goals 4,9,22,33,[35][36][37][38][39][40][41][42] Possible Cause(es) for Failure to Meet…”

Section: Future Considerationsmentioning

confidence: 99%

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Current Perspectives on the Attainment of Lipid Modification Goals Relating to the Use of Statins and Ezetimibe for the Prevention of Cardiovascular Disease in the United Kingdom

Reynolds¹,

Pottle²,

Quoraishi³

2021

VHRM

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Despite widespread evidence of the effectiveness of lipid modification for the reduction of cardiovascular disease (CVD) risk, lipid modification goals are commonly underachieved in the United Kingdom (UK). In order to understand current UK lipid management guidance and the corresponding attainment of recommended lipid lowering goals relating to treatment with statins and ezetimibe, a literature review was conducted using PubMed focusing on publications between January 2017 and February 2020 in order to capture the most up-to-date literature. Identified publications were reviewed against key clinical guidelines for lipid management in relation to CVD risk from the National Institute for Health and Care Excellence (NICE, CG181), the Scottish Intercollegiate Guidelines Network (SIGN, 149) and European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS). Cholesterol lowering goals are central to current lipid lowering therapy guidance, although specific goals vary depending on the guideline and patients' individual risk profile. Current guidance by NICE and SIGN specifies that treatment should achieve a greater than 40% reduction in non-high-density lipoprotein cholesterol (non-HDL-C) at 3 months of treatment, while the ESC/EAS place emphasis on the lowering of lowdensity lipoprotein (LDL-C) and total cholesterol. Yet, despite widespread availability of guidance and consistent messaging that lipid lowering goals should be ambitious, current evidence suggests a significant proportion of UK patients have sub-optimal reductions in cholesterol/non-HDL-C/LDL-C. The reasons for this are reported to be multifactorial, including a lack of compliance with guidelines, particularly regarding high-intensity statin prescribing, patient adherence, statin intolerance and statin reluctance as well as wider genetic factors. A number of possible strategies to improve current lipid management and attainment of lipid-lowering goals were identified, including improving the patient-healthcare professional partnership, conducting audits of local prescribing versus guidance, implementing plans for the refinement of current services and considering alternative options such as cost-effective single pill combinations for improving adherence.

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Section: Future Considerationsmentioning

confidence: 99%

“…• Provide patient counselling and education at the onset of treatment, including discussion about the overall safety, risks and benefits of treatment, 9 to ensure the patient is supported and understands the risk of CVD events 37,44 • Cost-effective single pill combinations 21 Statin intolerance AND/OR reluctance…”

Section: Underdosing Of Statinsmentioning

confidence: 99%

Current Perspectives on the Attainment of Lipid Modification Goals Relating to the Use of Statins and Ezetimibe for the Prevention of Cardiovascular Disease in the United Kingdom

Reynolds¹,

Pottle²,

Quoraishi³

2021

VHRM

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“…Limited uptake of high-intensity statin therapy [6][7][8][9][10], and underuse of ezetimibe contribute [6,11]. Suboptimal treatment adherence is a major issue, due to various reasons including adverse effects (whether perceived or real), and clinician inertia [9,12,13] This EAS Task Force recognizes that the new LDL-C goals for high and very-high-risk patients with dyslipidaemia are even more demanding than previously; indeed, in real-world practice only about one-third attain LDL-C goal [6]. Therefore, combination lipid lowering therapy should become the standard of care for these patients.…”

Section: Introductionmentioning

confidence: 99%

Practical guidance for combination lipid-modifying therapy in high- and very-high-risk patients: A statement from a European Atherosclerosis Society Task Force

et al. 2021

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Background and aims: This European Atherosclerosis Society (EAS) Task Force provides practical guidance for combination therapy for elevated low-density lipoprotein cholesterol (LDL-C) and/or triglycerides (TG) in highrisk and very-high-risk patients. Methods: Evidence-based review. Results: Statin-ezetimibe combination treatment is the first choice for managing elevated LDL-C and should be given upfront in very-high-risk patients with high LDL-C unlikely to reach goal with a statin, and in primary prevention familial hypercholesterolaemia patients. A proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor may be added if LDL-C levels remain high. In high and very-high-risk patients with mild to moderately elevated TG levels (>2.3 and < 5.6 mmol/L [>200 and < 500 mg/dL) on a statin, treatment with either a fibrate or high-dose omega-3 fatty acids (icosapent ethyl) may be considered, weighing the benefit versus risks. Combination with fenofibrate may be considered for both macro-and microvascular benefits in patients with type 2 diabetes mellitus. Conclusions: This guidance aims to improve real-world use of guideline-recommended combination lipid modifying treatment.

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“…Second, there was no difference in outcomes between the single-and separate-pill treatment strategies when data were adjusted for adherence, which suggests that the difference in adherence between the two groups played a major role. This offers robust support to use the single-pill combination of statin and ezetimibe in patients who are not at LDL-cholesterol target in people with different cardiovascular risk levels [11] as recently recommended [30].…”

Section: Discussionmentioning

confidence: 89%

Adherence to Lipid-Lowering Treatment by Single-Pill Combination of Statin and Ezetimibe

et al. 2021

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Introduction: Although several studies have shown that a simplified cardiovascular drug treatment leads to better treatment adherence, limited and conflicting findings have been reported on the separate or single-pill combination of the now recommended association between a statin and ezetimibe. We addressed this issue in a large cohort of patients newly treated with statins to whom ezetimibe was additionally administered, either separately or as a single-pill combination. Methods: A total of 256,012 patients (age 40-80 years) from the Lombardy Region (Italy) newly treated with statins during 2011-2013 were followed until 2018 to identify those to whom ezetimibe was added. The 2881 and 5351 patients who started a two-pill or a single-pill combination, respectively, of statin and ezetimibe were identified and matched for propensity score. Adherence to drug therapy at 1 year was measured as the ratio between the number of days in which the drug was available and the days of follow-up (the proportion of days covered; PDC). Patients who had a PDC[75% or\25% were, respectively, defined as highly and poorly adherent to drug therapy. Analysis was extended to the association between adherence and the risk of fatal/nonfatal cardiovascular events. Results: Compared to those prescribed a twopill combination, those prescribed a single-pill combination had an 87% (75-99%) greater odds of being highly adherent and a 79% (72-84%) lower odds of being poorly adherent to treatment. These advantages were manifest in all strata of age, sex, and clinical profile. The risk of

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An expert opinion paper on statin adherence and implementation of new lipid-lowering medications by the ESC Working Group on Cardiovascular Pharmacotherapy: Barriers to be overcome

Cited by 53 publications

References 60 publications

Current Perspectives on the Attainment of Lipid Modification Goals Relating to the Use of Statins and Ezetimibe for the Prevention of Cardiovascular Disease in the United Kingdom

Current Perspectives on the Attainment of Lipid Modification Goals Relating to the Use of Statins and Ezetimibe for the Prevention of Cardiovascular Disease in the United Kingdom

Practical guidance for combination lipid-modifying therapy in high- and very-high-risk patients: A statement from a European Atherosclerosis Society Task Force

Adherence to Lipid-Lowering Treatment by Single-Pill Combination of Statin and Ezetimibe

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