Lipid profile changes associated with changing available formulary statins: removing higher potency agents

To review the fasting lipid panel changes that occurred after removing higher potency statins from a prescription formulary.

Retrospective chart review.

Researchers compiled data for patients in a medical clinic receiving pharmacy benefits from a particular managed care plan. Patients enrolled in the benefits program at least between June 2006 and June 2007 were evaluated for atorvastatin use before January 1, 2007. After January 1, patients on atorvastatin were prescribed new statins according to the program's preferred drug list. Patients treated with atorvastatin were reviewed for fasting lipid panel results while on atorvastatin; these results then were compared with fasting lipid panels after the formulary change took place. Total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride values were examined for changes. Appropriateness of the replacement statin also was evaluated using statin equivalency charts.

Values for total cholesterol, low-density lipoprotein, and triglycerides were not significantly different from baseline to follow-up. High-density lipoprotein values did significantly increase over the study period. Only 34% of statin prescriptions were considered appropriately converted to equipotent or higher potency doses. The mean time to documentation of statin conversion was 2.9 months.

Removing higher potency statins from the formulary did not ignificantly change a population's fasting lipid panel except for a significant increase in high-density lipoprotein. Although multiple factors may have contributed to this effect, the results of this investigation suggest that changing formulary statins will not alter the surrogate lipoprotein markers associated with poor cardiovascular outcomes.