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Non-statin lipid-lowering therapy over time in very-high-risk patients: effectiveness of fixed-dose statin/ezetimibe
Julius L Katzmann1, Francesc Sorio-Vilela2, Eugen Dornstauder3
1Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Germany. julius.katzmann@medizin.uni-leipzig.de.
Insights
High-potency statin use increased, but non-statin lipid-lowering therapies (LLT) remain underutilized, especially by general practitioners. Fixed-dose combinations of statins and ezetimibe improved LDL-C reduction, yet many patients still have uncontrolled levels.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Many patients with very-high atherosclerotic cardiovascular disease risk do not achieve recommended LDL-C targets.
- Real-world data on non-statin lipid-lowering therapies (LLT) and fixed-dose combinations (FDC) effectiveness is limited.
Purpose of the Study:
- To investigate prescription trends of oral non-statin LLT.
- To evaluate the real-world effectiveness of non-statin LLT, including FDCs, on LDL-C levels.
Main Methods:
- Retrospective analysis of electronic medical records in Germany (2013-2018).
- Included outpatients at very-high cardiovascular risk treated by general practitioners and cardiologists.
- Examined prescription patterns and LDL-C reduction with various LLT regimens.
Main Results:
- Prescriptions for high-potency statins (atorvastatin, rosuvastatin) significantly increased from 2013 to 2018.
- Non-statin LLT prescriptions remained low and stable, particularly among general practitioners.
- Combination therapy with statins and ezetimibe, especially FDCs, showed greater LDL-C reduction (28.4%) compared to separate pills (19.4%), but many patients remained uncontrolled (<70 mg/dL).
Conclusions:
- High-potency statin use is increasing, but non-statin LLT are underutilized by general practitioners.
- Fixed-dose combinations of statins and ezetimibe offer superior LDL-C reduction compared to separate pills.
- Despite combination therapy, a significant proportion of high-risk patients do not reach target LDL-C levels.
Background:
Many patients at very-high atherosclerotic cardiovascular disease risk do not reach guideline-recommended targets for LDL-C. There is a lack of data on real-world use of non-statin lipid-lowering therapies (LLT) and little is known on the effectiveness of fixed-dose combinations (FDC). We therefore studied prescription trends in oral non-statin LLT and their effects on LDL-C.
Methods:
A retrospective analysis was conducted of electronic medical records of outpatients at very-high cardiovascular risk treated by general practitioners (GPs) and cardiologists, and prescribed LLT in Germany between 2013 and 2018.
Results:
Data from 311,242 patients were analysed. Prescriptions for high-potency statins (atorvastatin and rosuvastatin) increased from 10.4% and 25.8% of patients treated by GPs and cardiologists, respectively, in 2013, to 34.7% and 58.3% in 2018. Prescription for non-statin LLT remained stable throughout the period and low especially for GPs. Ezetimibe was the most prescribed non-statin LLT in 2018 (GPs, 76.1%; cardiologists, 92.8%). Addition of ezetimibe in patients already prescribed a statin reduced LDL-C by an additional 23.8% (32.3 ± 38.4 mg/dL), with a greater reduction with FDC [reduction 28.4% (40.0 ± 39.1 mg/dL)] as compared to separate pills [19.4% (27.5 ± 33.8 mg/dL)]; p < 0.0001. However, only a small proportion of patients reached the recommended LDL-C level of < 70 mg/dL (31.5% with FDC and 21.0% with separate pills).
Conclusions:
Prescription for high-potency statins increased over time. Non-statin LLT were infrequently prescribed by GPs. The reduction in LDL-C when statin and ezetimibe were prescribed in combination was considerably larger for FDC; however, a large proportion of patients still remained with uncontrolled LDL-C levels.
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