[Lipid-lowering therapy and patient adherence in the MULTI GAP 2013 trial]

Dyslipidemia is a well-known cardiovascular risk factor. To achieve lipid targets patient adherence is a particularly important issue.

To assess adherence and persistence to statin therapy in patients with atherosclerotic disease who participated in the MULTI Goal Attainment Problem 2013 (MULTI GAP 2013) study. Patient adherence was assessed using estimation by the physicians in charge and analysis of pick up rate of prescribed statins in 319 patients based on data of National Health Insurance Fund Administration of Hungary.

In the MULTI GAP 2013 study, data from standard and structured questionnaires of 1519 patients were processed. Serum lipid values of patients treated by different healthcare professionals (general practitioners, cardiologists, diabetologists, neurologists, and internists), treatment adherence of patients assessed by doctors and treatment adherence based on data of National Health Insurance Fund Administration of Hungary were analysed. Satisfaction of doctors with results of statin therapy and the relationship between the level of adherence and serum lipid values were also evaluated.

Considering the last seven years of survey data, the use of more effective statins became more prevalent with an about 70% increase of prescriptions of atorvastatin and rosuvastatin from 49% to 83%. Patients with LDL-cholesterol level below 2.5 mmol/l had 8 prescriptions per year. In contrast, patients who had LDL-cholesterol levels above 2.5 mmol/l had only 5.3-6.3 prescriptions per year. Patients who picked up their statins 10-12 or 7-9 times per year had significantly lower LDL-cholesterol level than those who had no or 1-3 pick up. The 100% persistence assessed by doctors was significantly lower (74%) based on data from the National Health Insurance Fund Administration of Hungary. About half of the patients were considered to display 100% adherence to lipid-lowering therapy by their doctors, while data from the National Health Insurance Fund Administration of Hungary showed only 36%. In patients with better adherence (90-100%) LDL-cholesterol levels below 2.5 mmol/l were more frequent (59.5%) compared to those with worse adherence. Satisfaction of doctors with lipid targets achieved was 69-80% in patients with total cholesterol between 4.5 and 6 mmol/l, and satisfaction with higher cholesterol values was also high (53-54%).

The results show that doctors may overestimate patient adherence to lipid-lowering treatment. Based on data from the National Health Insurance Fund Administration of Hungary, satisfaction of doctors with high lipid level appears to be high. There is a need to optimize not only patient adherence, but adherence of doctors to lipid guidelines too.