Dataset Information

Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study.

ABSTRACT:

Objectives

To describe low-density lipoprotein (LDL) cholesterol management and lipid-lowering treatment patterns in patients with a cardiovascular (CV) event.

Design

Retrospective cohort study using Clinical Practice Research Datalink records linked with Hospital Episode Statistics data.

Setting

Routine clinical practice in the UK from 2006 to 2012.

Participants

Individuals ?18 years were selected at their first CV-related hospitalisation (first event cohort) if they had received ?2?lipid-lowering therapy prescriptions within 180 days beforehand. Patients were stratified into four mutually exclusive subgroups based on the presence or absence of vascular disease and of diabetes. Those with a second CV hospitalisation within 36 months were included in a separate cohort (second event cohort).

Primary and secondary outcome measures

LDL levels in the year prior to the CV event and 12 months later as well as measures of adherence to lipid-lowering therapy during the 12 months after the CV hospitalisation.

Results

There were 24?093 patients in the first event cohort, of whom 5274 were included in the second event cohort. Most received moderate intensity statins at baseline and 12 months. Among the four first event cohort subgroups at baseline, the proportions with an LDL of <1.8?mmol/L was similar between the two diabetic cohorts (36% to 38%) and were higher than those in the two non-diabetic cohorts (17% to 22%) and in the second event cohort (31%). An incremental 5% to 9% had an LDL below 1.8?mmol/L at 12 months, suggesting intensification of therapy. The proportion of adherent patients (medication possession ratio of?0.8) was highest for statins, ranging from 68% to 72%. For ezetimibe, the range was 65% to 70%, and for fibrates, it was 48% to 62%.

Conclusions

Despite the existence of effective therapies for lowering cholesterol, patients do not reach achievable LDL targets.

SUBMITTER: Danese MD

PROVIDER: S-EPMC5566621 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study.

Danese Mark D MD Gleeson Michelle M Kutikova Lucie L Griffiths Robert I RI Khunti Kamlesh K Seshasai Sreenivasa Rao Kondapally SRK Ray Kausik K KK Ray Kausik K KK

BMJ open 20170510 5

<h4>Objectives</h4>To describe low-density lipoprotein (LDL) cholesterol management and lipid-lowering treatment patterns in patients with a cardiovascular (CV) event.<h4>Design</h4>Retrospective cohort study using Clinical Practice Research Datalink records linked with Hospital Episode Statistics data.<h4>Setting</h4>Routine clinical practice in the UK from 2006 to 2012.<h4>Participants</h4>Individuals ≥18 years were selected at their first CV-related hospitalisation (first event cohort) if the ...[more]

PMID: 28495810

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Project description:ObjectivesTo compare treatment patterns, risk factors and cardiovascular disease (CVD) event rates in the UK from 2008 to 2017.DesignRetrospective cohort study using the Clinical Practice Research Datalink.SettingUK primary care.ParticipantsWe selected 10 annual cohorts of patients with documented CVD receiving lipid-lowering therapy and the subsets with myocardial infarction (MI). Each cohort included patients ≥18 years old, with ≥1 year of medical history and ≥2 lipid-lowering therapy prescriptions in the prior year.Primary and secondary outcome measuresFor each annual cohort, we identified cardiovascular risk factors and lipid-lowering therapy and estimated the 1-year composite rate of fatal and non-fatal MI, ischaemic stroke (IS) or revascularisation.ResultsThe documented CVD cohort mean age was 71.6 years in 2008 (N=173 424) and 72.5 (N=94 418) in 2017; in the MI subset, mean age was 70.1 years in 2008 (N=38 999) and 70.4 in 2017 (N=25 900). Both populations had larger proportions of men. In the documented CVD cohort, the proportion receiving high-intensity lipid-lowering therapy from 2008 to 2017 doubled from 16% to 32%; in the MI subset, the increase was 20% to 48%. In the documented CVD cohort, the proportion of patients with low-density lipoprotein cholesterol (LDL-C) <1.8 mmol/L increased from 28% to 38%; in the MI subset, the proportion with LDL-C <1.8 mmol/L increased from 32% to 42%. The composite event rate per 100 person-years declined over time, from 2.5 to 2.0 in the documented CVD cohort, and from 3.7 to 2.8 in the MI subset. After excluding revascularisation from the composite outcome, the decline in the event rate in both populations was substantially attenuated.ConclusionsDespite an increase in high-intensity therapy use and a decline in revascularisation, more than half of patients did not receive high-intensity lipid-lowering therapy by 2017 and incidence rates of MI and IS remained virtually unchanged.

Project description:BackgroundLipid-lowering therapy (LLT) is one of the key strategies for reducing the atherosclerotic cardiovascular disease (ASCVD) burden. However, little is known about the percentage of people in need of different LLT regimens to achieve optimal targets of low-density lipoprotein cholesterol (LDL-C), and the corresponding cost and benefit.MethodsWe conducted a simulation study based on the data from the nationwide China PEACE MPP population cohort (2015-2020), from which we included 2,904,914 participants aged 35-75 years from all the 31 provinces in mainland China. Participants were grouped based on their 10-year ASCVD risks, then entered into a Monte Carlo model which was used to perform LLT intensification simulation scenarios to achieve corresponding LDL-C goals in each risk stratification.ResultsAfter standardizing age and sex, the proportions of participants included at low, moderate, high, and very-high risk were 70.8%, 15.6%, 11.5%, and 2.1%, respectively. People who failed to achieve the corresponding LDL-C goals -8.1% at low risk, 19.6% at moderate risk, 53.2% at high risk, and 93.6% at very-high risk (either not achieving the goal or not receiving LLT)-would be in need of the LLT intensification simulation. After the use of atorvastatin 20 mg was simulated, over 99% of the population at low or moderate risk could achieve the LDL-C goals; while 11.3% at high and 24.5% at very-high risk would still require additional non-statin therapy. After the additional use of ezetimibe, there were still 4.8% at high risk and 11.3% at very-high risk in need of evolocumab; and 99% of these two groups could achieve the LDL-C goals after the use of evolocumab. Such LLT intensification with statin, ezetimibe, and evolocumab would annually cost $2.4 billion, $4.2 billion, and $24.5 billion, respectively, and prevent 264,170, 18,390, and 17,045 cardiovascular events, respectively.ConclusionsModerate-intensity statin therapy is pivotal for the attainment of optimal LDL-C goals in China, and around 10-25% of high- or very-high-risk patients would require additional non-statin agents. There is an opportunity to reduce the rising ASCVD burden in China by optimizing LLT.

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Dataset Information

Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study.

Objectives

Design

Setting

Participants

Primary and secondary outcome measures

Results

Conclusions

Publications

Management of lipid-lowering therapy in patients with cardiovascular events in the UK: a retrospective cohort study.

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