Attainment of Low-Density Lipoprotein Cholesterol Goals in Statin Treated Patients: Real-World Evidence From Australia

Talic, Stella; Marquina, Clara; Zomer, Ella; Asenso, Richard Ofori; Petrova, Marjana; Vargas-Torres, Sandra; Abushana, Dina; Wolfe, Rory; Lybrand, Sean; Thomson, David; Stratton, Giles; Liew, Danny

doi:10.1016/j.cpcardiol.2021.101068

Cited by 15 publications

(12 citation statements)

References 48 publications

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“…Therapeutic targets (defined in this study as low-density lipoprotein cholesterol less than or equal to 2 mmol/L) were met in only 36% of patients. 11 …”

Section: Examples Of Therapeutic Inertiamentioning

confidence: 99%

Therapeutic inertia

Usherwood

2024

Aust Prescr

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Summary Therapeutic inertia, sometimes referred to as clinical inertia, has been defined as failure to initiate or intensify therapy when therapeutic goals are not reached. Lack of initiation or intensification of treatment according to clinical guidelines has been linked to suboptimal control of a range of chronic conditions. Clinician factors contributing to therapeutic inertia include knowledge gaps; discomfort with uncertainty about the diagnosis, therapeutic target, or evidence; concerns about the safety of treatment intensification; and time constraints. Patient characteristics that may be associated with therapeutic inertia include male sex, older age, lower life expectancy, multiple comorbidities and clinical parameters that are close to target. There may be reasons other than therapeutic inertia that explain apparent undertreatment. Apparent inertia in prescribing may be accompanied by appropriate actions, such as provision of lifestyle advice or interventions to promote adherence to existing medication. Some patients choose not to intensify treatment. Interventions to reduce therapeutic inertia include access to evidence-based treatment guidelines and point-of-care tools, preferably integrated with clinical record systems; clinician education including educational visits; reminders; clinical audits with feedback and reflection on practice; shared decision-making; prompting by patients; and ambulatory or home monitoring (e.g. ambulatory blood pressure monitoring).

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“…Therapeutic targets (defined in this study as low-density lipoprotein cholesterol less than or equal to 2 mmol/L) were met in only 36% of patients. 11 …”

Section: Examples Of Therapeutic Inertiamentioning

confidence: 99%

Therapeutic inertia

Usherwood

2024

Aust Prescr

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“…We assumed that all people would receive first-line metformin as per current Australian guidelines [43], while the proportions of other GLTs as second-line therapies were based on Morton et al [46] (32% for DPP4i, 30% for SGLTi, 17% for sulfonylurea, and 6% for GLP-1 RA). We also assumed that once a nonfatal MI/stroke occurs, 95% of people would receive statins and 5% would receive non-statins [47]. Acute costs for CVD included non-fatal MI, non-fatal stroke, and death due to CVD.…”

Section: Direct Healthcare Costsmentioning

confidence: 99%

Projecting the Health and Economic Burden of Cardiovascular Disease Among People with Type 2 Diabetes, 2022–2031

et al. 2023

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ObjectiveThe aim was to project the health and economic outcomes of cardiovascular disease (CVD) among people with type 2 diabetes from Australian public healthcare and societal perspectives over the next decade. Methods A dynamic multistate model with yearly cycles was developed to project cardiovascular events among Australians with type 2 diabetes aged 40-89 years from 2022 to 2031. CVD risk (myocardial infarction [MI] and stroke) in the type 2 diabetes population was estimated using the 2013 pooled cohort equation, and recurrent cardiovascular event rates in the type 2 diabetes with established CVD population were obtained from the global Reduction of Atherothrombosis for Continued Health (REACH) registry. Costs and utilities were derived from published sources. Outcomes included fatal and non-fatal MI and stroke, years of life lived, quality-adjusted life years (QALYs), total healthcare costs, and total productivity losses. The annual discount rate was 5%, applied to outcomes and costs.

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“…A retrospective cohort study published in 2021 that included 61,407 Australian patients treated with statins showed that only 34.9 and 55.1% achieved LDL-C levels ≤77.3 mg/dl. The patients diagnosed with T2DM, stroke, or chronic heart disease were more likely to achieve LDL-C goals (90). A recent study using the Estonian Myocardial Infarction Registry, which included more than 6,000 MI cases per period, has shown that statin prescription had raised from 44% in the period 2004-2005 to 67% in the period 2017-2018 (91).…”

Section: Overtreatment and Undertreatment In Lipid-lowering Therapies...mentioning

confidence: 99%

Undertreatment or Overtreatment With Statins: Where Are We?

García-Fernández-Bravo

Torres-Do-Rego

López‐Farré

et al. 2022

Front. Cardiovasc. Med.

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Statins, in addition to healthy lifestyle interventions, are the cornerstone of lipid-lowering therapy. Other low-density lipoprotein (LDL)-lowering drugs include ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. As new evidence emerges from new clinical trials, therapeutic goals change, leading to renewed clinical guidelines. Nowadays, LDL goals are getting lower, leading to the “lower is better” paradigm in LDL-cholesterol (LDL-C) management. Several observational studies have shown that LDL-C control in real life is suboptimal in both primary and secondary preventions. It is critical to enhance the adherence to guideline recommendations through shared decision-making between clinicians and patients, with patient engagement in selecting interventions based on individual values, preferences, and associated conditions and comorbidities. This narrative review summarizes the evidence regarding the benefits of lipid-lowering drugs in reducing cardiovascular events, the pleiotropic effect of statins, real-world data on overtreatment and undertreatment of lipid-lowering therapies, and the changing LDL-C in targets in the clinical guidelines of dyslipidemias over the years.

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Attainment of Low-Density Lipoprotein Cholesterol Goals in Statin Treated Patients: Real-World Evidence From Australia

Cited by 15 publications

References 48 publications

Therapeutic inertia

Therapeutic inertia

Projecting the Health and Economic Burden of Cardiovascular Disease Among People with Type 2 Diabetes, 2022–2031

Undertreatment or Overtreatment With Statins: Where Are We?

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