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Residual cardiovascular risk in patients who received lipid-lowering treatment in a real-life setting: retrospective
Valentina Perrone1, Diego Sangiorgi1, Stefano Buda1
1CliCon S.r.l., Health, Economics & Outcomes Research, Ravenna, Italy.
Insights
Patients on statins still face residual cardiovascular risk. Further interventions are needed to manage this risk, as statins alone may not fully prevent heart attacks or strokes.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Cardiovascular disease remains a leading cause of mortality.
- Statins are primary agents for lipid-lowering therapy.
- Residual cardiovascular risk persists despite guideline-adherent statin treatment.
Purpose of the Study:
- To evaluate residual cardiovascular risk in patients treated with statins.
- To compare cardiovascular event rates with additional lipid-lowering agents.
Main Methods:
- Retrospective observational study using administrative and laboratory data.
- Inclusion criteria: statin prescription between 2009-2011, 12-month follow-up.
- Propensity score matching used for comparing treatment groups.
Main Results:
- 27,330 patients included; 770 met guideline criteria but had elevated LDL-C.
- Elevated incidence rates of myocardial infarction/stroke observed across risk categories.
- Fibrate therapy associated with lower risk of myocardial infarction/stroke compared to statins.
Conclusions:
- Residual cardiovascular risk is evident even with guideline-directed statin therapy.
- Interventions to manage residual risk during statin treatment are necessary.
- Exploring additional lipid-lowering agents may be beneficial.
Introduction:
The objective of this study was twofold: 1) to assess the residual cardiovascular (CV) risk among patients treated with statins according to guidelines and at the recommended dosages; and 2) to assess the difference, if any, in the frequency of CV events when patients were treated with other lipid-lowering agents alongside statins.
Methods:
A retrospective observational study including one local health unit was conducted. Administrative databases were linked to laboratory test database in order to collect cholesterol values at baseline. Patients were included if they had filled at least one prescription for statins between January 1, 2009 and December 31, 2011; patients' records were considered for a 12-month time span.
Results:
A total of 27,330 patients treated with statins were included (50% male, mean age 68.0±11.5 years). Among them, 770 were treated with statins according to guidelines and at the recommended dosages and had a low density lipoprotein-cholesterol value below the therapeutic target. Nevertheless, the risk of myocardial infarction or stroke remained: incidence rates were 1.3±1.0 per patient per year for moderate CV risk, 4.1±2.6 for high risk, and 12.5±11.0 for very high risk. This incremental risk was confirmed further using the Cox model, by correcting for age, sex, use of antiplatelet and/or antihypertensive therapy, and adherence to treatment. As a second analysis, we compared, after a propensity score matching, patients extracted from the overall sample who were treated with fibrates. Based on the Cox model, patients on fibrates had a risk for myocardial infarction or stroke lower than patients on statins.
Conclusion:
Among patients treated with statins according to guidelines and at the recommended dosages, a residual CV risk was observed. We concluded that intervention for managing residual CV risk during statin therapy should be implemented.
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