Diagnosis and Treatment of Patients With Severe Hypercholesterolemia in Real Outpatient Practice (According to the Recvasa Registry)

Ершова, А. И.; Мешков, А. Н.; Yakushin, S. S.; Loukianov, М. М.; Moseychuk, K. A.; Martsevich, S. Yu.; Zagrebelnyy, A. V.; Vorobyev, A. N.; Переверзева, К. Г.; Правкина, Е. А.; Kozminskiy, A. N.; Boytsov, S. А.

doi:10.20996/1819-6446-2014-10-6-612-616

Cited by 18 publications

(15 citation statements)

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“…Несмотря на то, что ситуация с назначением терапии статинами за последнее десятилетие улучшилась, эти показатели широко варьируют и нередко остаются на достаточно низком уровне. Так, по данным россий- Adherence to Statin Therapy Приверженность к терапии статинами ских регистров пациентов с сердечно-сосудистыми заболеваниями (ССЗ) статины были назначены менее 2% больных, перенесших мозговой инсульт, только в 5-14% случаев пациентам с ишемической болезнью сердца (ИБС) до госпитализации по поводу острого инфаркта миокарда (ОИМ), в 17,8% случаев -больным с ССЗ и гиперхолестеринемией (ГХС) [3][4][5][6].…”

Section: Adherence To Statin Therapy приверженность к терапии статинамиunclassified

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Adherence to Statins Therapy of High and Very High Cardiovascular Risk Patients in Real Clinical Practice: Diagnostics and Possible Ways to Solve the Problem (According to the PRIORITY Observational Study)

Martsevich

Lukina

Кутишенко

et al. 2019

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. To study adherence to treatment with generic statins prescribed to patients with high and very high cardiovascular risk in routine clinical practice, as well as the possible impact of educational training of doctors on compliance with clinical guidelines and changes in patient adherence to treatment. Material and methods. The study was prospective, with educational training for physicians on the main provisions of current clinical guidelines prior to the program. It included 3 visits over 12 weeks: inclusion visit (V0), and visits after 1 and 3 months of follow-up (V1 and V3). The use of generic atorvastatin or rosuvastatin was recommended for all patients. To assess adherence the following surveys were used: medical survey (all visits), the original questionnaire to assess the potential and the actual commitment to taking statins and the causes of non-adherence, and the Morisky-Green 8-question test (visits V0 and V3) to evaluate overall adherence to drug treatment. The patients who started the drug taking according to the medical recommendations and continued it during the study were considered as adherents. Patients who started but stopped taking the drug for 12 weeks were considered as partially non-adherent. Patients who refused to take the recommended statin were considered as non-adherents. The prescribed doses of statins and medical tactics in the titration of doses, as well as the achievement of the target level of low-density lipoprotein cholesterol (LDL cholesterol) were evaluated. Results. 112 (37.5%) of the 298 patients with baseline indications for taking statins did not take these drugs. According to the medical survey at V0 a total of 286 (96%) patients were potential adherents to medical recommendations; at V3 262 (88%) patients were adherent to statin treatment; 34 patients were partially non-adherent, 1 – was non-adherent, and 1 – dropped out of the study immediately after V0. According to the original questionnaire, potential adherence was assessed in 281 patients: 244 (86.8%) were potentially adherent, 37 (13.2%) – partially non-adherent. At V3, out of 294 patients who filled in the original questionnaire, 260 (88.5%) were adherent, 26 (8.8%) – partly non-adherent, 8 (2.7%) – nonadherent. The Morisky-Green questionnaire was filled in by 292 patients: at V0, 106 patients (36.3%) had treatment adherence, non-adherence – 186 patients (63.7%). By V3, an increase in total adherence was found: 159 patients (54.5%) were adherent, and 133 (45.5%) – non-adherent. The lipid profile was evaluated in 231 patients in V1 and in 285 ones – in V3. The target LDL cholesterol level was reached by V1 in 47 (20.3%) patients, and in 184 (79.7%) patients – was not. Dose titration occurred in 56 patients. By V3, 121 (42.4%) patients reached the target level of LDL cholesterol, and 164 – did not. The results of the lipid profile analysis were erroneously interpreted in 21 patients. Conclusion The results of the medical survey and the original questionnaire for assessing adherence predominantly coincided. The Morisky-Green test does not accurately reflect patients' commitment to taking a particular drug. Clinical inertness of doctors in the titration of statin doses and achievement of target LDL cholesterol levels were found as well as erroneous interpretation of the LDL cholesterol level. Educational trainings for doctors had a positive effect on the implementation of clinical guidelines, and also contributed to increasing patient adherence to medical recommendations.

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Section: Adherence To Statin Therapy приверженность к терапии статинамиunclassified

“…Rational Pharmacotherapy in Cardiology 2018;14(6) / Рациональная Фармакотерапия в Кардиологии 2018;14(6) …”

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Adherence to Statins Therapy of High and Very High Cardiovascular Risk Patients in Real Clinical Practice: Diagnostics and Possible Ways to Solve the Problem (According to the PRIORITY Observational Study)

Martsevich

Lukina

Кутишенко

et al. 2019

Racionalʹnaâ farmakoterapiâ v kardiologii

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“…It would allow patients to decrease hypotensive drug dosage frequency and reduce drug load, which would result in a decrease of side effects of antihypertensive agents. Given a wide variety of hypotensive drugs practicing physicians are not always aware of the optimal time of drug intake and dosage during the day under outpatient conditions 5,6,7,8 .…”

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Influence of altiazem pp-180 on hemodynamic parameters in arterial hypertension patients under outpatient conditions

Zhakiyeva

Tulegenova

Ibragimova

et al. 2018

Bangladesh J Med Sci

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Background: The objective is to study the time-dependent hemodynamic effects of altiazem PP-180 and the blood circulation parameters in patients with arterial hypertension of the II degree in outpatient polyclinic conditions.Methods: The study included 78 patients with essential II grade AH aged 42 to 73 years (mean age of 57.65 ± 0.6). Among them were 28 men and 50 women. The duration of the disease ranged from 4 to 23 years (an average of 9.2 ± 0.12). All the groups involved in the research were divided into two subgroups: the main group and the control group. The control group included 30 patients, who took A-180 once a day at non-fixed hours. The main group included 48 patients, who were divided into random subgroups depending on the time they took A-180 once a day. Within 3 days prior to treatment and during the 10-day treatment course, the medical staff measured all the pateints’ heart rate and blood pressure by NC Korotkoff every 3 hours, 6 times a day. The patients’ heart rate and blood pressure were alternatively self-measured. Prior to treatment and at the end of the 10-day course of therapy with altiazem PP-180, all the patients involved in the research underwent ECG examination and echocardiography on the Aloka machine (Japan).Results: The most favorable hemodynamic support for the hypotensive effect of altiazem PP-180 was observed when patients took it at 7 a.m., 10 a.m. and 10 p.m. in their normal mode of work and rest. When patients took altiazem PP-180 at 1 p.m, 4 p.m. and 7 p.m., its hypotensive effect was due to less favorable hemodynamic support.Conclusions: When taken at different hours of the day - both fixed and non-fixed hours - altiazem PP-180 caused a distinct hypotensive effect in patients with the II degree AH in outpatient polyclinic conditions.Bangladesh Journal of Medical Science Vol.17(3) 2018 p.360-368

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“…В среднем каждый третий пациент с высоким и очень высоким ССР -т. е. имеющий все показания к назначению статинов, -на момент включения в программу препараты не получал (пациенты группы 1 исследования "ПРИОРИТЕТ"). Хотя даже такие показатели выглядят оптимистично по сравнению с результатами ряда регистров больных ИБС, согласно которым на амбулаторном этапе лечения статины получают не более 20% больных [4,5,9]. По обобщенным данным исследования EUROASPIRE IV (A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries) при выписке из стационара пациентам с ИБС (пациентам очень высокого ССР) статины были назначены лишь в 9,6% случаев (по результатам опроса больных -в 14,0%), по данным российских центров, принимавших участие в этом исследовании, только 7,5% больных ИБС при выписке из стационара назначаются статины [10].…”

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“…Достижение целевых уровней ХС ЛНП остается ведущей проблемой при лечении статинами. Этот вывод представленной работы согласуется с результатами других исследований [8][9][10][11][12]. Отмечено, что более высокое значение целевого уровня ХС ЛНП, определенное для пациентов высокого ССР по сравнению с больными очень высокого ССР, достигается в большем числе случаев, особенно при использовании препарата розувастатина, как и в исследовании STELLAR (the Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin) [13].…”

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Features and main problems of treating patients with high and very high cardiovascular risk with statins in real clinical practice (according to the data of the “PRIORITET” research)

Martsevich

Lukina

Kutishenko

et al. 2018

Cardiovasc Ther Prev

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Aim. To determine the features and main problems of statin therapy, as well as assess the possibility of achieving the target level of lipid pattern in patients with high and very high cardiovascular risk (CVR) in real clinical practice.Material and methods. The design of the “PRIORITET” observational program is an open observational study. Patients with high and very high CVR were divided into 3 groups in accordance with the initial data: (1) not taking statins, (2) taking statins, but not reaching the target low-density lipoprotein cholesterol (LDL-C) level, (3) taking statins with the achievement of the target LDL-C level, which is justified in replacing the statin inside the class — adverse effects (AE), high price, etc. Within 12 weeks 3 visits of patients to hospitals were carried out: baseline visit (B0), visit 1 month after the study initiation (B1) and visit 3 months after the study initiation (B3). The choice of atorvastatin or rosuvastatin was assessed by the doctors.Results. Groups 1, 2 and 3 included 112, 170 and 16 people, respectively. At B0, 145 (48,7%) patients were prescribed atorvastatin, and 153 (51,3%) — rosuvastatin. Three people dropped out of the study to B3, 295 patients completed the program. Lipid pattern of 285 patients were analyzed: 121 (41%) people (101 with very high CVR and 20 with high CVR) achieved the target LDL-C level, the remaining 164 (59%) patients (CVR — 156 and 8, respectively) — no. The most pronounced dynamics of LDL=C level was revealed in group 1, the differences between group 1 and groups 2 and 3 are highly statistically significant (p<0,0001). There were no differences in the frequency of reaching the target LDL-C level between patients taking atorvastatin or rosuvastatin. The target level of LDL-C (p=0,003) in the treatment of rosuvastatin in patients with high CVR was reached significantly more often than in patients with very high CVR. Also 3 non-serious AEs were reported. On average, in 9% of cases, reaching the target level of LDL-С during visits B1 and B3 was wrong interpreted by the attending physicians.Conclusion. The main problems of statin therapy in real clinical practice are the wrong interpretation of reaching the target level of LDL-C, inertness of doctors in titrating of statins doses and achieving the target level of lipid pattern. It may be the cause of reduced efficiency and deterioration of lipid-lowering therapy results in patients with high and very high CVR. The results of the “PRIORITET” study demonstrated the possibility of improving the practice of statins use and its accordance with clinical guidelines.Skibitsky V. V. on behalf of the working group of the “PRIORITET” researchWorking Group of the “PRIORITET” study: Voronina V. P. (Moscow), Zelenova T. I. (Moscow), Sladkova T.A. (Moscow), Alekseeva A. I. (Tula), Barabanova T. Yu. (Tula), Zotova A. S. (Tula), Kolomeitseva T. M. (Tula), Prikhod’ko T. N. (Tula), Pazelt E. A. (Nizhny Novgorod), Khramushev N. Yu. (Nizhny Novgorod), Skibitsky A. V. (Krasnodar), Alekseeva V. V. (Saratov), Lazareva E. V. (Saratov).

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Diagnosis and Treatment of Patients With Severe Hypercholesterolemia in Real Outpatient Practice (According to the Recvasa Registry)

Cited by 18 publications

References 4 publications

Adherence to Statins Therapy of High and Very High Cardiovascular Risk Patients in Real Clinical Practice: Diagnostics and Possible Ways to Solve the Problem (According to the PRIORITY Observational Study)

Adherence to Statins Therapy of High and Very High Cardiovascular Risk Patients in Real Clinical Practice: Diagnostics and Possible Ways to Solve the Problem (According to the PRIORITY Observational Study)

Influence of altiazem pp-180 on hemodynamic parameters in arterial hypertension patients under outpatient conditions

Features and main problems of treating patients with high and very high cardiovascular risk with statins in real clinical practice (according to the data of the “PRIORITET” research)

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