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Optimization of the Statin Therapy Algorithm in Outpatient Practice: Adherence and Economic Benefits

https://doi.org/10.20996/1819-6446-2020-11-10

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Abstract

Aim. To study adherence to recommended treatment, additional clinical and economic benefits of a titration-free statin therapy regimen.

Material and methods. Ambulatory patients (n=300) with a high or very high risk of hypercholesterolemia who have indications for statin treatment for primary or secondary prevention of cardiovascular diseases is included in a non-randomized trial. Patients are divided into 2 groups. Group 1 had a titration regimen of statins in accordance with current recommendations (group 1A [n=50] – primary cardiovascular prevention; group 1B [n=100] – secondary cardiovascular prevention). Group 2 received a titration-free statin regimen in fixed doses (group 2A [n=50] – primary cardiovascular prevention; group 2B [n=100] – secondary cardiovascular prevention). Patients were prescribed atorvastatin (10-80 mg/day) or rosuvastatin (10- 40 mg/day). Group 1 patients had visits to the doctor after 1, 3, 6 and 12 months from the start of statin use, group 2 patients after 3 and 12 months. Treatment adherence, effects on surrogate and hard endpoints, and cost-effectiveness of the two statin regimens were evaluated.

Results. The target level of low-density lipoprotein cholesterol (LDL-C) after 12 months in group 2 was achieved in 56.4% of patients versus 53.4% in group 1. The average level of LDL-C decreased by 1.84±0.44 mmol / l in group 2 versus a decrease of 1.61±0.47 mmol / L in group 1. The costeffectiveness ratio was 9658.72 rubles in group 2 versus 8341.73 rubles in group 1 for a 1 mmol / l LDL-C level decrease in 1 patient within a year. An increase in annual costs per patient in group 2 compared with group 1 by 75.76 rubles reduced the relative risk of developing a combined endpoint by 1% per year.

Conclusion. The use of a titration-free statin treatment regimen allowed us not only to more effectively control of LDL-c levels in patients with high and very high cardiovascular risk compared to the traditional statin therapy regimen, but also to obtain economic advantages in patients with high and very high cardiovascular risk.

About the Authors

S. A. Davitashvili
Clinical Hospital №1, Administrative Department of the President of the Russian Federation
Russian Federation

Semen A. Davitashvili, MD, Cardiologist,

Starovolynskaya ul. 10, Moscow, 121352



D. V. Nebieridze
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

David V. Nebieridze, MD, PhD, Professor, Head of Department of Metabolic Disorders Prevention,

Petroverigsky per. 10, Moscow, 101990

eLibrary SPIN 1834-929




N. M. Akhmedzhanov
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Nadyr M. Akhmedzhanov, MD, PhD, Leading Researcher, Department of Metabolic Disorders Prevention,

Petroverigsky per. 10, Moscow, 101990

eLibrary SPIN 2987-9035




A. S. Lishuta
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Alexey S. Lishuta, MD, PhD, Associate Professor, Chair of Hospital Therapy №1, 

Trubetskaya ul. 8-2, Moscow, 119991

eLibrary SPIN 4365-478




A. S. Safaryan
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Anush S. Safaryan, MD, PhD, Leading Researcher, Department of Metabolic Disorders Prevention,

Petroverigsky per. 10, Moscow, 101990

eLibrary SPIN 4172-6428




References

1. 2018 Demographic and Health Indicators of the Russian Federation. Statistical Digest. Moscow: Rosstat; 2019 (In Russ)

2. Demographic yearbook of Russia. Moscow: Rosstat; 2018 (In Russ.)

3. Bauersachs R., Zeymer U., Brière J.B., et al. Burden of Coronary Artery Disease and Peripheral Artery Disease: A Literature Review. Cardiovasc Ther. 2019;829:50-4. DOI:10.1155/2019/8295054.

4. GBD 2017 Causes of Death Collaborators (2018) Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736-88. DOI:10.1016/S0140-6736(18)32203-7.

5. GBD 2017 SDG Collaborators (2018) Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):2091- 138. DOI:10.1016/S0140-6736(18)32281-5.

6. Nebieridze D.V., Akhmedzhanov N.M., Davitashvili S.A., et al. Studying the Possibility of Optimizing the Statin Therapy Algorithm in Outpatient Practice. Rational Pharmacotherapy in Cardiology. 2020;16(4):528-35 (In Russ.) DOI:10.20996/1819-6446-2020-08-04.

7. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis. 2016;253:281-344. DOI:10.1016/j.atherosclerosis.2016.08.018.

8. Diagnosis and correction of lipid metabolism disorders in order to prevent and treat atherosclerosis. Russian recommendations (VI revision). Atherosclerosis and Dyslipidemia. 2017;(3):5-22 (In Russ.)

9. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3168-209. DOI:10.1016/j.jacc.2018.11.002.

10. Tariff agreement for payment of medical care provided under the territorial compulsory health insurance program of the city of Moscow for 2020 [cited 10/04/2020]. Available at: https://www.mgfoms.ru/strahovye-kompanii/tarifi/2020 (In Russ.)

11. Akhmedzhanov N.M., Nebieridze D.V., Safaryan A.S., et al. Analysis of hypercholesterolemia prevalence in the outpatient practice (according to the ARGO study): PART I. Rational Pharmacotherapy in Cardiology. 2015;11(3):253-60 (In Russ.) DOI:10.20996/1819-6446-2015-11-3-253-260.

12. Martsevich S.Y., Lukina Y.V., Kutishenko N.P., et al. Features and main problems of treating patients with high and very high cardiovascular risk with statins in real clinical practice (according to the data of the “PRIORITET” research). Cardiovascular Therapy and Prevention. 2018;17(6):52-60 (In Russ.) DOI:10.15829/1728-8800-2018-6-52-60.

13. Akhmedzhanov N.M., Nebieridze D.V., Safaryan A.S., et al. Lipid-lowering therapy in outpatient practice (according to the ARGO-2 study). Rational Pharmacotherapy in Cardiology. 2016;12(2):147-153. (In Russ.) DOI:10.20996/1819-6446-2016-12-2-147-153.

14. Ershova A.I., Meshkov A.N., Yakushin S.S., et al. Diagnosis and treatment of patients with severe hypercholesterolemia in real outpatient practice (according to the RECVASA registry). Rational Pharmacotherapy in Cardiology. 2014;10(6):612-6 (In Russ.) DOI:10.20996/1819-6446-2014-10-6-612-616.

15. Balanova Y.A., Kontsevaya A.V., Imaeva A.E., et al. Economic losses due to low coverage of lipid-lowering therapy in patients with cardiovascular diseases in the Russian Federation. Rational Pharmacotherapy in Cardiology. 2018;14(5):716-24 (In Russ.) DOI:10.20996/1819-6446-2018-14-5-716-724.

16. Reiner Ž., De Backer G., Fras Z. et al. Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries - Findings from the EUROASPIRE IV survey. Atherosclerosis. 2016;246:243-50. DOI:10.1016/j.atherosclerosis.2016.01.018.

17. Hsu H.Y., Lin C.J., Lee Y..S, et al. Efficacy of more intensive lipid-lowering therapy on cardiovascular diseases: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2020 Jul 13;20(1):334. DOI:10.1186/s12872-020-01567-1.

18. Xie C., Zhu M., Hu Y., Wang K. Effect of Intensive and Standard Lipid-Lowering Therapy on the Progression of Stroke in Patients With Coronary Artery Syndromes: A Meta-Analysis of Randomized Controlled Trials. J Cardiovasc Pharmacol. 2020;75(3):222-228. DOI:10.1097/FJC.0000000000000784.

19. Alkhalil M. Effects of intensive lipid-lowering therapy on mortality after coronary bypass surgery: A meta-analysis of 7 randomised trials. Atherosclerosis. 2020;293:75-8. DOI:10.1016/j.atherosclerosis.2019.12.006.


For citation:


Davitashvili S.A., Nebieridze D.V., Akhmedzhanov N.M., Lishuta A.S., Safaryan A.S. Optimization of the Statin Therapy Algorithm in Outpatient Practice: Adherence and Economic Benefits. Rational Pharmacotherapy in Cardiology. 2021;17(1):49-55. (In Russ.) https://doi.org/10.20996/1819-6446-2020-11-10

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)