Understanding patients’ perspective of statin therapy: can we design a better approach to the management of dyslipidaemia? A literature review

Chee, Ying Jie; Chan, Hian Hui Vincent; Tan, Ngiap Chuan

doi:10.11622/smedj.2014099

Cited by 31 publications

(33 citation statements)

References 47 publications

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“…26 The fact of poor awareness/management of FH might be explained by variables. [27][28][29] Of them, hospitals or cardiologists can play a significant role because they are likely to be the first to encounter the patients and their families, but the clinical care is not well developed and provided in China to date. Patients' knowledge and compliance are also reasons for great concern.…”

Section: Discussionmentioning

confidence: 99%

Familial Hypercholesterolemia Phenotype in Chinese Patients Undergoing Coronary Angiography

Zhu

et al. 2017

ATVB

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Large-scale clinical studies of FH have been reported from many countries, 2,7-16 but the features of FH in China are largely unknown. 17 Furthermore, the actual prevalence of FH is likely to be underestimated in the past, and the FH trait is masked by the CAD phenotype or more common risk factors without the genetically elevated cholesterol levels.3 Hence, the aim of present study was to investigate patients with FH phenotype and further provide molecular data on mutations for patients with FH in the Division of Dyslipidemia of Fu Wai Hospital, the only national center of dyslipidemia in China.© 2016 American Heart Association, Inc. Objective-Familial hypercholesterolemia (FH) is characterized by an elevated low-density lipoprotein cholesterol and increased risk of premature coronary artery disease. However, the general picture and mutational spectrum of FH in China are far from recognized, representing a missed opportunity for the investigation. Approach and Results-A total of 8050 patients undergoing coronary angiography were enrolled. The diagnosis of clinical FH was made using Dutch Lipid Clinic Network criteria, and the information of relatives was obtained by inquiring for the probands or from their own medical records of certain clinics/hospitals. Molecular analysis of FH was performed using target exome sequencing in LDLR (low-density lipoprotein cholesterol receptor gene), APOB (apolipoprotein B gene), and PCSK9 (proprotein convertase subtilisin/kexin type 9 gene). As a result, 3.5% of the patients with definite/ probable FH phenotype (definite 1.0% and probable 2.5%) were identified. Women FH had fewer premature coronary artery disease (women <60, or men <55 years of age) when compared with men FH (70.6% versus 82.7%; P<0.001), whereas angiographic extension of coronary artery disease was significantly increased with FH diagnosis in both men and women (P<0.001). Patterns of medication use in definite/probable FH were as follows: nontreated, 20.6%; low intensity, 6.0%; moderate intensity, 68.3%; and high intensity, 5.0%. However, none of them had achieved the lowdensity lipoprotein cholesterol <100 mg/dL. Additionally, mutational analysis was performed in 245 definite/probable FH cases, and risk variants were identified in 115 patients, giving a detection rate of 46.9%. Conclusions-We showed firsthand a common identification but poor treatment of patients with FH phenotype in Chinese coronary angiography patients. Genetic data in our FH cases might contribute to update the frequency and spectrum of Chinese FH scenarios. Materials and MethodsMaterials and Methods are available in the online-only Data Supplement. Results Prevalence of FHBasic characteristics of the study population are summarized in Table 1. The mean (±SD) age of the participants was 57.2±10.5 years, of whom 68.7% were men and 83.8% were with CAD and 37.8% with pCAD (<55 years for men and <60 years for women). The mean total cholesterol and LDL-C were 165.25±50.58 and 101.54±43.63 mg/dL, respectively. In the sample, there were 1.0% def...

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Section: Discussionmentioning

confidence: 99%

Familial Hypercholesterolemia Phenotype in Chinese Patients Undergoing Coronary Angiography

Zhu

et al. 2017

ATVB

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“…Other studies, however, have found higher treatment rates, including 75% for hypertension and 81–87% and 90% for dyslipidaemia . Reported barriers to the treatment of hypertension, diabetes and dyslipidaemia in the general population have included provider disagreement with clinical recommendations, the absence of an adequate patient care plan, overestimation of the effectiveness of diet control as a treatment modality, complex treatment regimens, poor patient education, failure to appreciate the severity of potential complications, perceived and actual drug side effects, and depression or stress/anxiety hindering the adoption of a new treatment regimen . Older HIV‐infected patients often face additional barriers to non‐HIV medication adherence such as neurocognitive dysfunction, substance use disorders, food insecurity, and limited social support .…”

Section: Discussionmentioning

confidence: 99%

High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC

Levy

Hart

et al. 2017

HIV Medicine

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Objectives With the increasing impact of cardiovascular disease among populations aging with HIV, contemporary prevalence estimates for predisposing metabolic comorbidities will be important for guiding the provision of relevant lifestyle and pharmacological interventions. We estimated the citywide prevalence of hypertension, type 2 diabetes, dyslipidemia, and obesity; examined differences by demographic subgroups; and assessed clinical correlates. Methods Utilizing an electronic medical record (EMR) database from the DC Cohort – a multi-center prospective cohort study of HIV outpatients – we assessed the period prevalence of metabolic comorbidities between 2011–2015 using composite definitions that incorporated diagnoses, pharmacy records, and clinical/laboratory results. Results Of 7,018 adult patients (median age 50 years; 77% black), 50% (95% CI: 49–51) had hypertension, 13% (95% CI: 12–14) had diabetes, 48% (95% CI: 47–49) had dyslipidemia, and 35% (95% CI: 34–36) had obesity. Hypertension was more prevalent among blacks, diabetes and obesity were more prevalent among females and blacks, dyslipidemia was more prevalent among males and whites, and comorbidities were more prevalent among older patients (all p<0.001). For many patients, evidence of treatment for these comorbidities was not available in the EMR. Longer time since HIV diagnosis, greater duration of antiretroviral treatment, and having controlled immuno-virological parameters were associated with metabolic comorbidities. Conclusions These findings underscore the pervasive burden of metabolic comorbidities among HIV-infected persons, serve as the basis for future analyses characterizing their impact on subsequent adverse cardiovascular outcomes, and highlight the need for an increased focus on the prevention and control of comorbid complications in this population.

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“…There is no similar systematic study using the Health Belief Model that has assessed attitudes toward drugs in nonpsychiatric patients taking medications for other chronic conditions. A few studies of patients' attitudes toward drugs have been conducted in epilepsy [46] and hypertension [47,48], but the only article that systematically applied the Health Belief Model is a review of the literature on drug attitudes toward statins, in which published studies are reinterpreted with the use of this model [49]. …”

Section: Limited Studies On the Attitudes Toward Medications In Medicmentioning

confidence: 99%

Reviving Research on Medication Attitudes for Improving Pharmacotherapy: Focusing on Adherence

Cuevas

Leon

2017

Psychother Psychosom

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There is little current interest in research into patients' attitudes toward medications. In the 1960s, psychiatric researchers including Uhlenhuth, Rickels and Covi focused on this area, but this research topic needs to be revived in the 21st century. The Health Belief Model may hold potential for doing this. This model was initially developed by 2 health psychologists, Rosenstock and Becker, to explain why patients did not follow medical interventions. The application of this model to study medication adherence in psychiatric outpatients has provided multiple findings including the conclusions that adherence is associated with: (1) the balance between internal and external health control beliefs, (2) psychological reactance, (3) patients' attitudes toward prescribed drug treatment in general and (4) the balance between the necessity of taking medications versus the concerns derived from adverse drug reactions (ADRs). Poor adherence is associated with several cognitive styles of patients, including: (1) high internal and external health control beliefs (patients who feel that their health is controlled both by external factors and their own beliefs), (2) higher psychological reactance, (3) pharmacophobia (present in 1/6 patients) and (4) skepticism about medications (a high concern for ADRs and a low belief in the necessity of taking medications). All of these findings suggest that shared decision-making is particularly important in fostering adherence in psychiatric patients. Two wider applications of this article can be made: (1) opening psychiatry to advances in clinical psychology and (2) expanding studies on attitudes toward medications to other medical disciplines.

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Understanding patients’ perspective of statin therapy: can we design a better approach to the management of dyslipidaemia? A literature review

Cited by 31 publications

References 47 publications

Familial Hypercholesterolemia Phenotype in Chinese Patients Undergoing Coronary Angiography

Familial Hypercholesterolemia Phenotype in Chinese Patients Undergoing Coronary Angiography

High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC

Reviving Research on Medication Attitudes for Improving Pharmacotherapy: Focusing on Adherence

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