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)

The high prevalence of lipid metabolism disorders in the Russian population and their contribution to cardiovascular risk require an optimization of their pharmacotherapy in clinical practice.Aim. To study adherence to recommended treatment, additional clinical and economic benefits of a titration-free statin therapy regimen.Material and methods. Ambulatory patients (n=300) with a high or very high risk of hypercholesterolemia who have indications for statin treatment for primary or secondary prevention of cardiovascular diseases is included in a non-randomized trial. Patients are divided into 2 groups. Group 1 had a titration regimen of statins in accordance with current recommendations (group 1A [n=50] – primary cardiovascular prevention; group 1B [n=100] – secondary cardiovascular prevention). Group 2 received a titration-free statin regimen in fixed doses (group 2A [n=50] – primary cardiovascular prevention; group 2B [n=100] – secondary cardiovascular prevention). Patients were prescribed atorvastatin (10-80 mg/day) or rosuvastatin (10- 40 mg/day). Group 1 patients had visits to the doctor after 1, 3, 6 and 12 months from the start of statin use, group 2 patients after 3 and 12 months. Treatment adherence, effects on surrogate and hard endpoints, and cost-effectiveness of the two statin regimens were evaluated.Results. The target level of low-density lipoprotein cholesterol (LDL-C) after 12 months in group 2 was achieved in 56.4% of patients versus 53.4% in group 1. The average level of LDL-C decreased by 1.84±0.44 mmol / l in group 2 versus a decrease of 1.61±0.47 mmol / L in group 1. The costeffectiveness ratio was 9658.72 rubles in group 2 versus 8341.73 rubles in group 1 for a 1 mmol / l LDL-C level decrease in 1 patient within a year.An increase in annual costs per patient in group 2 compared with group 1 by 75.76 rubles reduced the relative risk of developing a combined endpoint by 1% per year.Conclusion. The use of a titration-free statin treatment regimen allowed us not only to more effectively control of LDL-c levels in patients with high and very high cardiovascular risk compared to the traditional statin therapy regimen, but also to obtain economic advantages in patients with high and very high cardiovascular risk.

Section: Discussionunclassified

Optimization of the Statin Therapy Algorithm in Outpatient Practice: Adherence and Economic Benefits

Davitashvili

Небиеридзе²,

Ахмеджанов³

et al. 2021

“…В работе были использованы данные, полученные в нерандомизированном неконтролируемом исследовании ПРИОРИТЕТ, дизайн и результаты которого отражены в предыдущих публикациях [12,13].…”

Section: материал и методыunclassified

Pharmacoeconomic Analysis of Therapy with Generic Statin Drugs in Patients with High and Very High Cardiovascular Risk (According to the Study PRIORITY)

Martsevich¹,

Lukina²,

Кутишенко³

2020

Self Cite

Aim. To perform a pharmacoeconomical assessment of the use of generic statin drugs in patients with high and very high cardiovascular risk (CVR) in real clinical practice based on the data of the study PRIORITY.Material and methods. The PRIORITY study included 298 patients with high (29; 9.7%) and very high (269, 90.3%) CVR. All patients were recommended to take the reproduced drugs of atorvastatin and rosuvastatin in an individually prescribed dose. After 1 month (B1), if the target level of lowdensity lipoprotein cholesterol (LDL-C) was not reached, the statin dose was titrated. After 3 months of follow-up (B3), the hypolipidemic effect of statin therapy was evaluated. 295 people completed the study, 285 patients had the results of the lipid profile. To perform a pharmacoeconomic analysis and evaluate the “cost/effectiveness” ratio, we used the prices of generic statins in one of the online pharmacies. The effectiveness of statins was determined by the LDL-C reduction, as well as by the percentage of achieving the target LDL-C level.Results. At the first stage of the pharmacoeconomic analysis, the criterion for the effectiveness of 3-month lipid-lowering therapy was a decrease in LDL-C level by 1 mmol/l. The median and interquartile range of the ratio “cost/effectiveness” indicator for atorvastatin was 658.2 (431.5; 1257.1) RUB/mmol/l, and for rosuvastatin – 621.0 (390.7; 940.6) RUB/mmol/l (p=0.45). The results of a comparative assessment of the “cost/effectiveness” ratio (with the abovementioned effectiveness indicator) in subgroups of patients with high and very high CVR, with the achievement and nonachievement of the target level of LDL-C, adherent and non-adherent to statins, revealed the economic advantage of statins in groups of adherent patients (p=0.35), high-risk patients (p<0.0001) and individuals who reached the target level of LDL-C (p=0.002) when compared with the corresponding comparison groups. Despite the revealed high effectiveness of rosuvastatin at doses of 20-40 mg/day (assessed by the cost/effectiveness of achieving the target values of LDL-C for specific doses of statins), calculation of the “cost/effectiveness” ratio for each reproduced statin, in general, showed a higher economic effectiveness of atorvastatin.Conclusion. Pharmacoeconomic analysis of therapy with generic statin drugs, performed according to the data of the non-randomized uncontrolled study, allows to justify the economic efficiency and advantages of these drugs in various subgroups of patients who need statin therapy.

“…человек [1]. Одной из ведущих причин высокой смертности от ССЗ является низкая долгосрочная приверженность терапии [2][3][4][5][6][7][8][9][10]: после выписки пациента из стационара этот показатель не превышает 50%, независимо от заболевания [3][4][5][6][7][8][9][10]. Низкая приверженность длительной лекарственной терапии связана с уменьшением выраженности терапевтического эффекта, снижением качества жизни и влечет значительные финансовые потери [4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionunclassified

“…Одной из ведущих причин высокой смертности от ССЗ является низкая долгосрочная приверженность терапии [2][3][4][5][6][7][8][9][10]: после выписки пациента из стационара этот показатель не превышает 50%, независимо от заболевания [3][4][5][6][7][8][9][10]. Низкая приверженность длительной лекарственной терапии связана с уменьшением выраженности терапевтического эффекта, снижением качества жизни и влечет значительные финансовые потери [4][5][6][7][8][9][10][11][12][13][14][15]. Например, суммарный экономический ущерб от гиперхолестеринемии в 2016 г. в Российской Федерации составил более 1 трлн Рублей [8], при этом наиболее часто пациенты с ССЗ после выписки из стационара самостоятельно прекращают прием статинов [4][5][6][7][8][9][10].…”

Section: Introductionunclassified

“…Низкая приверженность длительной лекарственной терапии связана с уменьшением выраженности терапевтического эффекта, снижением качества жизни и влечет значительные финансовые потери [4][5][6][7][8][9][10][11][12][13][14][15]. Например, суммарный экономический ущерб от гиперхолестеринемии в 2016 г. в Российской Федерации составил более 1 трлн Рублей [8], при этом наиболее часто пациенты с ССЗ после выписки из стационара самостоятельно прекращают прием статинов [4][5][6][7][8][9][10]. Использовались разнообразные способы улучшения приверженности [3][4][5][6][7][8][9][10][11], но самыми результативными были вмешательства, направленные на поведенческие реакции самого пациента, а не какие-либо иные действия, исходящие от лечащего врача или работников лечебного учреждения [4][5][6][7][8][9][10][11][12][13][14][15][16].…”

Section: Introductionunclassified

See 1 more Smart Citation

A Randomized Open Clinical Study of the Atherosclerosis Treatment Information Video Effect on Adherence to Long-Term Therapy in Patients with Cardiovascular Diseases

Bulaeva

Наумова

Semenova

et al. 2021

Aim. Study the effect of a study video, which was created by researchers and devoted to the atherosclerosis development and the effect of statin therapy on atherosclerotic plaque, on adherence to long-term therapy in patients with high or very high risk of cardiovascular complications.Material and methods. 120 patients admitted to hospital with cardiovascular diseases were included in the study. Patients were randomized into 2 groups: in the main group (n=60), the information video edited by the researchers was shown to patients on the eve of discharge, in addition to a printed brochure on lifestyle and diet modification, and in the control group (n=60), patients were given only a standard brochure. The motivating video shows the damage to the cardiovascular system by the atherosclerotic process and the beneficial effect on the body of constant intake of statins. After 1 and 3 months after discharge from the hospital, telephone calls were made, after which the patients had to visit the center for an objective examination by a researcher and control of laboratory parameters. After 1 month, 110 patients visited the center, after 3 months, 98 respondents visited the center.Results. The group with the information video demonstration noted more frequent adherence to medical recommendations compared to the control: after 1 month, 52 (96%) patients continued treatment versus 48 (86%) patients, 3 months after discharge 48 (96%) patients continued treatment versus 38 (79%) patients (p<0.05). After 1 month, 38 (70%) patients in the intervention group continued taking statins versus 29 (43%) respondents in the control group (p<0.05), 3 months after discharge, 40 (80%) patients in the intervention group continued to take statins versus 33 (69%) control patients (p<0.09).Conclusion. Demonstration of a motivating video about the effect of statins on the atherosclerosis course increases patient adherence to medicinal therapy, including adherence to statins.