Kenneth McDonough

Effect of Rosuvastatin Compared with Other Statins on Lipid Levels and National Cholesterol Education Program Goal Attainment for Low-Density Lipoprotein Cholesterol in a Usual Care Setting

Study Objective. To compare, in a usual care setting, the effects of rosuvastatin and other 3‐hydroxy‐3‐methylglutaryl coenzyme A inhibitors (statins) on lipid levels and on goal attainment of low‐density lipoprotein cholesterol (LDL) levels from the National Cholesterol Education Program (NCEP) third report of the Adult Treatment Panel (ATP III).

Effectiveness of rosuvastatin versus atorvastatin in reducing lipid levels and achieving low-density-lipoprotein cholesterol goals in a usual care setting

PURPOSE The effectiveness of rosuvastatin versus atorvastatin in reducing lipid levels and achieving low-density-lipoprotein (LDL) cholesterol goals in patients treated in a usual care setting was studied. METHODS Electronic medical and pharmacy administrative claims from a western U.S. health plan with approximately 8 million covered members were extracted and used in this retrospective, longitudinal cohort study. Patients age 18 years or older who were newly initiated on rosuvastatin or atorvastatin between August 1, 2003, and June 30, 2004, were included. Propensity-score matching on baseline characteristics was used to minimize selection bias between groups. Administrative claims and medical records were used to assign patients a cardiovascular risk status and corresponding LDL cholesterol goal using guidelines from the National Cholesterol Education Program (NCEP). Changes in lipid levels and attainment rates of goal LDL cholesterol levels were estimated after accounting for baseline covariates using regression techniques. RESULTS A total of 453 patients met the study criteria. The mean dose of rosuvastatin was 11 mg compared with 15 mg for atorvastatin. After adjusting for baseline differences between groups, patients receiving rosuvastatin had significantly greater mean percent reductions in LDL cholesterol, total cholesterol, and non-high-density-lipoprotein (non-HDL) cholesterol than did patients receiving atorvastatin (p < 0.001 for all comparisons). No significant differences were found in HDL cholesterol and triglyceride levels between groups. Attainment rates for NCEP LDL cholesterol goals were significantly higher in patients receiving rosuvastatin. CONCLUSION Patients treated in a usual care setting with rosuvastatin had significantly greater reductions in LDL cholesterol, non-HDL cholesterol, and total cholesterol levels compared with those receiving atorvastatin. Patients receiving rosuvastatin were more likely to attain NCEP LDL cholesterol goals compared with patients treated with atorvastatin.

Metabolic syndrome in a screened worksite sample : Prevalence and predictors

Relatively limited contemporary information is available about the magnitude of, and factors associated with, the metabolic syndrome in adult men and women. The purpose of our observational study was to describe the prevalence and predictors of the metabolic syndrome in a sample of employed adults attending a worksite cardiovascular screening program. The study sample consisted of 871 men and women between the ages of 21 and 77 years from 6 locations of the parent company. These individuals attended an employer-sponsored cardiovascular screening and wellness program during 2003. A standardized questionnaire was administered to all study participants and a number of different coronary risk factors were measured. Approximately 27% of the study sample was classified as having the metabolic syndrome. Men, persons with a history of hypertension, heart disease, or stroke, sedentary individuals, and those with an increased heart rate and higher levels of C-reactive protein were associated with presence of the metabolic syndrome. A relatively similar risk factor profile was noted in persons without a self-reported history of prior cardiovascular disease. The results of our cross-sectional observational study suggest that the prevalence of the metabolic syndrome is considerable. A number of demographic, comorbid, and other factors are associated with this syndrome. Increased attention to the metabolic syndrome, and modification of predisposing factors, remains of considerable public health and clinical importance.

Levels of, and Factors Associated with, C-Reactive Protein in Employees Attending a Company-Sponsored Cardiac Screening Program

Background: Relatively limited contemporary information is available about the distribution of, and factors associated with, levels of C-reactive protein (CRP) in adult men and women. The purpose of our descriptive study was to examine the prevalence and predictors of this marker of inflammation in a sample of employed adults attending a worksite cardiovascular screening program. Methods: The study sample consisted of 876 men and women between the ages of 21 and 77 years from 6 locations of the parent company. These individuals attended an employer-sponsored cardiovascular screening and wellness program during 2003. A standardized questionnaire was administered to all study participants, and a number of different coronary risk factors were measured. Results: Approximately 25% of the study sample was classified as having elevated CRP levels (≧3 mg/l). Women, obese individuals, subjects with increasing heart rate and higher levels of serum triglycerides were more likely to have elevated concentrations of CRP than the corresponding comparison groups. Subjects who reported regularly exercising, individuals with a history of heart disease and those with lower total cholesterol levels were less likely to have elevated CRP levels. A relatively similar risk factor profile was noted in individuals without a self-reported history of prior cardiovascular disease. Conclusions: The results of our cross-sectional observational study suggest that the prevalence of elevated CRP levels in the general adult population is considerable. A number of demographic, comorbid and other factors are associated with this inflammatory marker of increased risk of cardiovascular disease, which demands increased attention and modification of potential predisposing factors.

The Performance Gap between Clinical Trials and Patient Treatment for Dyslipidemia: A Comprehensive Review

Cardiovascular disease is the primary cause of death in the US. Controlling dyslipidemia, particularly elevated low-density lipoprotein-cholesterol (LDL-C), is considered a primary strategy to reduce cardiovascular risk. HMG-CoA reductase inhibitors (statins) are the most effective agents available to lower LDL-C. Moreover, evidence from numerous prospective clinical trials has shown that statins reduce both cardiovascular disease morbidity and mortality in patients with dyslipidemia. Newer evidence has resulted in updated consensus guidelines that list reducing LDL-C values to a greater degree than has previously been recommended as therapeutic options for certain at-risk populations. Despite these conclusive benefits, most patients at risk for cardiovascular disease have LDL-C values that are above recommended goal values. Observational studies have identified several problems in managing dyslipidemia. These include infrequent screening for dyslipidemia by measuring fasting lipid panels, not prescribing statin therapy in high-risk individuals, incomplete monitoring in patients receiving statin therapy, and a general inability to attain recommended LDL-C goal values in patients receiving statin therapy. This gap between efficacy from clinical trials and treatment in clinical practice is particularly important to managed care organizations because statin therapy can reduce cardiovascular risk and may result in reduced overall healthcare costs. Many drug-based and system-based strategies can be implemented by managed care organizations to reduce this gap. Using high-potency statins, selecting appropriate initial statin doses based on the degree of LDL-C reduction that is required, and combination therapy (e.g. a statin with ezetimibe, bile acid sequestrants, niacin, or fibric acid derivatives) can result in greater LDL-C lowering than by simply using the lowest starting dose of any given statin. System-based models that utilize specific disease state management clinics, therapeutic intervention programs that target population-based improvements in LDL-C goal attainment, and judicious formulary management that includes therapeutic conversion initiatives have all been successfully implemented in managed care environments.

An Evaluation of the Factors Associated with Statin Dose Management and Low-Density Lipoprotein-Cholesterol Goal Attainment

PurposeTo examine factors associated with HMG-CoA reductase inhibitor (statin) management and the effect of therapeutic modifications on patients’ abilities to reach their low-density lipoprotein-cholesterol (LDL-C) goal in a sample of managed care enrollees.MethodsThis retrospective analysis utilized electronic pharmacy claims, medical claims, and laboratory data, and explored the occurrence and magnitude of modifications to statin regimens. Patients aged ≥18 years who were initiated on statin therapy between 1 January 2001 and 31 December 2001 and who were continuously enrolled for 6 months prior to and 12 months following the index prescription were included. A subgroup analysis incorporated laboratory data to determine whether patients attained their LDL-C treatment goal.ResultsA total of 38 567 patients were identified: 50.6% were female and patients had a mean age of 63.6 ±13.4 years. During a 1-year follow-up, 16.1% (n = 6220) had a modification to their statin regimen. Multivariate analysis showed that significant predictors of regimen modification included age, sex, index statin, index statin potency, and the occurrence of a cardiac reperfusion procedure or acute hospitalization during the 6-month pre-index period (p < 0.05). A subgroup of 254 patients with laboratory data was identified: 57.9% of these patients were female and their mean age was 66.6 ± 10.5 years. Of this cohort, only 14.2% had a modification to their statin regimen. Goal attainment was significantly more frequent among patients whose statin regimen was modified compared with patients whose statin regimen was not modified (72.2% vs 52.8%; p = 0.0294).ConclusionThe low occurrence of therapeutic modifications and goal attainment may indicate a need for greater awareness of the importance of effective statin use.