Association of a Combined Measure of Adherence and Treatment Intensity With Cardiovascular Outcomes in Patients With Atherosclerosis or Other Cardiovascular Risk Factors Treated With Statins and/or Ezetimibe

Khunti, Kamlesh; Danese, Mark D.; Kutikova, Lucie; Catterick, David; Sorio-Vilela, Francisco; Gleeson, Michelle; Seshasai, Sreenivasa Rao Kondapally; Brownrigg, Jack; Ray, Kausik K.

doi:10.1001/jamanetworkopen.2018.5554

Cited by 83 publications

(73 citation statements)

References 33 publications

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“…For example, before guideline release, 24–31% of largely secondary prevention patients and 15% of primary prevention patients received high-intensity statins; 7 , 8 and, among patients initiating statins for secondary prevention 2010–2013, 74% were started on ‘moderate’ intensity (27–43% reduction, including atorvastatin 20 mg) and 23% on high-intensity (>42% reduction). 23 Consistent with this, the present data showed approximately 70–75% of statins were low-/medium-intensity in 2014. The present study also revealed that the decline in use of low-/medium-intensity statins began before the 2014 guidelines.…”

Section: Discussionsupporting

confidence: 90%

Prescription of suboptimal statin treatment regimens: a retrospective cohort study of trends and variation in English primary care

et al. 2020

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BackgroundSince 2014 English national guidance recommends ‘high-intensity’ statins, reducing low-density lipoprotein (LDL) cholesterol by ≥40%.AimTo describe trends and variation in low-/medium-intensity statin prescribing and assess the feasibility of rapid prescribing behaviour change.Design and settingA retrospective cohort study using OpenPrescribing data from all 8142 standard NHS general practices in England from August 2010 to March 2019.MethodStatins were categorised as high- or low-/medium-intensity using two different thresholds, and the proportion prescribed below these thresholds was calculated. The authors plotted trends and geographical variation, carried out mixed-effects logistic regression to identify practice characteristics associated with breaching of guidance, and used indicator saturation to identify sudden prescribing changes.ResultsThe proportion of statins prescribed below the recommended 40% LDL-lowering threshold has decreased gradually from 80% in 2011/2012 to 45% in 2019; the proportion below a pragmatic 37% threshold decreased from 30% to 18% in 2019. Guidance from 2014 had minimal impact on trends. Wide variation was found between practices (interdecile ranges 20% to 85% and 10% to 30% respectively in 2018). Regression identified no strong associations with breaching of guidance. Indicator saturation identified several practices exhibiting sudden changes towards greater guideline compliance.ConclusionBreaches of guidance on choice of statin remain common, with substantial variation between practices. Some have implemented rapid change, indicating the feasibility of rapid prescribing behaviour change. This article discusses the potential for a national strategic approach, using data and evidence to optimise care, including targeted education alongside audit and feedback to outliers through services such as OpenPrescribing.

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Section: Discussionsupporting

confidence: 90%

Prescription of suboptimal statin treatment regimens: a retrospective cohort study of trends and variation in English primary care

et al. 2020

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“…Non-adherent patients had a lower reduction in cardiovascular risk compared with adherent patients, independent of the intensity of lipid-lowering agent used. However, also within the non-adherent group, the benefits in terms of cardiovascular risk became progressively attenuated with the reduction of the intensity regimen [36].…”

Section: Impact Of Choice Of Combination On Outcomesmentioning

confidence: 99%

“…With the importance of adherence to outcomes being established by the data above, the choice of the agents that should be prescribed and eventually combined to optimize CVD prevention is also important. A retrospective cohort study using primary care data from [ 29,000 patients newly treated with statins and/or ezetimibe assessed the combined impact of adherence and treatment intensity on cardiovascular outcomes [36]. Adherent patients who received high-intensity therapy had the lowest cardiovascular risk, which gradually increased in the group of adherent patients taking moderate-intensity or low-intensity statins.…”

Section: Impact Of Choice Of Combination On Outcomesmentioning

confidence: 99%

Facing the Challenge of Lowering Blood Pressure and Cholesterol in the Same Patient: Report of a Symposium at the European Society of Hypertension

et al. 2020

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“…However, better adherence is associated with lower risk of adverse outcomes (L. Wei et al, 2002). A retrospective cohort study including patients new to lipid-lowering therapy showed that adherent patients participating in high-intensity therapy had a 40% lower risk of ASCVD compared with non-adherent patients participating in low-intensity therapy (Khunti et al, 2018). Intervention tailored to each patient's requirements using optimal treatment, education about the treatment, regular monitoring and feedback, reminder systems and reducing regimen complexity may be effective to achieve adequate reduction in LDL-C levels and improve cardiovascular outcomes (Kripalani, Yao, & Haynes, 2007).…”

Section: Adherencementioning

confidence: 99%

Targeting the peptidase PCSK9 to reduce cardiovascular risk: Implications for basic science and upcoming challenges

Nishikido

Ray

2019

British J Pharmacology

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LDL cholesterol (LDL‐C) plays a central role in the progression of atherosclerosis. Statin therapy for lowering LDL‐C reduces the risk of atherosclerotic cardiovascular disease and is the recommended first‐line treatment for patients with high LDL‐C levels. However, some patients are unable to achieve an adequate reduction in LDL‐C with statins or are statin‐intolerant; thus, PCSK9 inhibitors were developed to reduce LDL‐C levels, instead of statin therapy. PCSK9 monoclonal antibodies dramatically reduce LDL‐C levels and cardiovascular risk, and promising new PCSK9 inhibitors using different mechanisms are currently being developed. The absolute benefit of LDL‐C reduction depends on the individual absolute risk and the achieved absolute reduction in LDL‐C. Therefore, PCSK9 inhibitors may provide the greatest benefits from further LDL‐C reduction for the highest risk patients. Here, we focus on PCSK9‐targeted therapies and discuss the challenges of LDL‐C reduction for prevention of atherosclerotic cardiovascular disease.

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Association of a Combined Measure of Adherence and Treatment Intensity With Cardiovascular Outcomes in Patients With Atherosclerosis or Other Cardiovascular Risk Factors Treated With Statins and/or Ezetimibe

Cited by 83 publications

References 33 publications

Prescription of suboptimal statin treatment regimens: a retrospective cohort study of trends and variation in English primary care

Prescription of suboptimal statin treatment regimens: a retrospective cohort study of trends and variation in English primary care

Facing the Challenge of Lowering Blood Pressure and Cholesterol in the Same Patient: Report of a Symposium at the European Society of Hypertension

Targeting the peptidase PCSK9 to reduce cardiovascular risk: Implications for basic science and upcoming challenges

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