Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal achievement in clinical practice in Europe and Canada

Gitt, Anselm K.; Drexel, Heinz; Feely, J.; Ferrières, Jean; González-Juanàtey, José Ramón; Thomsen, Kristian K; Leiter, Lawrence A.; Lundman, Pia; Silva, Pedro Mendonça; Pedersen, Terje R.; Wood, David; Jünger, Claus; Dellea, Pam S.; Sazonov, Vasilisa; Chazelle, François; Kastelein, John J.P.

doi:10.1177/1741826711400545

Cited by 149 publications

(108 citation statements)

References 30 publications

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“…Many studies showed that there is a strong disparity between guidelines and clinical reality with regard to statin use and LDL-C goal attainment. (6,(21)(22)(23)(24) A summary of published data on lipid goal attainment is provided in table 3. It must be acknowledged, however, that poor lipid goal attainment to a great deal is due to physician inertia rather than poor patient adherence; physician inertia is therefore not the major focus of this work.…”

Section: Where Do We Stand: Poor Adherence To Statin Usementioning

confidence: 99%

Comprehensive efforts to increase adherence to statin therapy

et al. 2017

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Section: Where Do We Stand: Poor Adherence To Statin Usementioning

confidence: 99%

Comprehensive efforts to increase adherence to statin therapy

et al. 2017

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“…Overall, 48.2% of patients did not achieve their LDL-C goal (according to European Society of Cardiology [ESC] recommendations) [37]. Among high-risk patients (defined as established CVD, diabetes, or ESC-SCORE C5%), 46.8% did not attain an LDL-C level \97 mg/dl [38]. The more recent DYSIS-II study, which enrolled 3867 patients with recent ACS and 6794 patients with stable coronary heart disease (CHD), showed that, among those receiving lipid-lowering treatment, only 26% of patients with ACS and 31% of those with stable CAD achieved an LDL-C \70 mg/dl.…”

Section: Inability Of Some Patients To Attain Desirable Low-mentioning

confidence: 99%

Defining the Place of Ezetimibe/Atorvastatin in the Management of Hyperlipidemia

Ferreira

Silva

2016

Am J Cardiovasc Drugs

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Statin-ezetimibe combinations are a potentially advantageous therapeutic option for high-risk patients who need additional lowering of low-density lipoprotein cholesterol (LDL-C). These combinations may overcome some of the limitations of statin monotherapy by blocking both sources of cholesterol. Recently, a fixed-dose combination with atorvastatin, one of the most extensively studied statins, was approved and launched in several countries, including the USA. Depending on atorvastatin dose, this combination provides LDL-C reductions of 50-60%, triglyceride reductions of 30-40%, and highdensity lipoprotein cholesterol (HDL-C) increases of 5-9%. Studies comparing the lipid-lowering efficacy of the atorvastatin-ezetimibe combination with the alternatives of statin dose titration or switching to a more potent statin consistently showed that combination therapy provided greater LDL-C reduction, translating into a greater proportion of patients achieving lipid goals. Simvastatinezetimibe combinations have been shown to reduce the incidence of major atherosclerotic events in several clinical settings to a magnitude that seems similar to that observed with statins for the same degree of absolute LDL-C lowering. The atorvastatin-ezetimibe combination has also been shown to induce the regression of coronary atherosclerosis measured by intravascular ultrasound in a significantly greater proportion of patients than atorvastatin alone. Atorvastatin-ezetimibe combinations are generally well tolerated. Previous concerns of a possible increase in the incidence of cancer with ezetimibe were dismissed in large trials with long follow-up periods. In this paper, we examine the rationale for an atorvastatin-ezetimibe combination, review the evidence supporting it, and discuss its potential role in the management of dyslipidemia. Key PointsStatin-ezetimibe combinations are a realistic treatment option for patients who do not achieve low-density lipoprotein cholesterol (LDL-C) targets while receiving statin monotherapy and for patients prone to dose-dependent statin side effects.The IMPROVE-IT trial was the first to demonstrate a reduction in cardiovascular events with ezetimibe.Recently, combination therapy with atorvastatin plus ezetimibe was also associated with greater coronary plaque regression than atorvastatin alone.

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“…Control of elevations in LDL-C is reported at about 48% in the EU [Gitt et al 2012], 53% in the UK [Kotseva et al 2012], but was decidedly improved at approximately 73% for all patients in the Lipid Treatment Assessment Project 2 (L-TAP-2) [Waters et al 2009]. In high-risk patients, however, target attainment was lower at 67%, and only 35% of patients with two or more risk factors achieved optional goals of LDL-C < 1.8 mmol/L.…”

Section: Emerging Drug Therapiesmentioning

confidence: 99%

Reducing residual risk: modern pharmacochemistry meets old-fashioned lifestyle and adherence improvement

Kones¹

2013

Therapeutic Advances in Cardiovascular Disease

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Despite remarkable advances in identifying and managing coronary heart disease, the global burden of cardiovascular (CV) risk and levels of undetected, subclinical heart disease remain enormous. Substantial numbers of patients do not reach their therapeutic goals, others are unable to tolerate the treatments, half may fail to adhere to their programs, and in those who do attain their targets, major cardiovascular events may continue. Wellknown risk factors, such as obesity and diabetes, have now gained the upper hand, with no evidence-based remedy capable of reversing this trend. All told, less than 1% of American adults and adolescents qualify for ideal CV health; world-wide, the growing prevalence of CV risk factors in children is imposing. A number of novel emerging drug therapies are in development, some recently approved for use in patients with familial hypercholesterolemia.Hopefully, they will contribute significantly to the current therapeutic armamentarium. However, for meaningful improvement in total and residual CV risk, an optimal mix of all available modalities will likely be necessary, including earlier and more effective prevention, aggressive medical care, revascularization and device implantation, judicious use of novel agents, and reengineering of the environment.

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Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal achievement in clinical practice in Europe and Canada

Cited by 149 publications

References 30 publications

Comprehensive efforts to increase adherence to statin therapy

Comprehensive efforts to increase adherence to statin therapy

Defining the Place of Ezetimibe/Atorvastatin in the Management of Hyperlipidemia

Reducing residual risk: modern pharmacochemistry meets old-fashioned lifestyle and adherence improvement

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