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Switching from high-efficacy lipid-lowering therapies to simvastatin and low-density lipoprotein cholesterol goal attainment in coronary heart disease/coronary heart disease-equivalent patients
Background The availability of generic simvastatin in 2006 has prompted substantial changes in formulary recommendations for lipid-management agents. Objective To assess the impact of switches from high-efficacy lipid-lowering therapy to simvastatin on low-density lipoprotein cholesterol (LDL-C) and...
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| Published in: | Journal of clinical lipidology 2010-11, Vol.4 (6), p.491-500 |
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| container_start_page | 491 |
| container_title | Journal of clinical lipidology |
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| creator | Tunceli, Kaan, PhD Sajjan, Shiva G., PhD Ramey, Dena R., BA Neff, David R., DO Tershakovec, Andrew M., MD, MPH Hu, X. Henry, MD, PhD Tomassini, Joanne E., PhD Foody, JoAnne M., MD |
| description | Background The availability of generic simvastatin in 2006 has prompted substantial changes in formulary recommendations for lipid-management agents. Objective To assess the impact of switches from high-efficacy lipid-lowering therapy to simvastatin on low-density lipoprotein cholesterol (LDL-C) and goal attainment in coronary heart disease (CHD) or CHD risk-equivalent patients in a managed care setting. Methods In this retrospective observational study, we estimated the least squares mean difference in the percent change from baseline LDL-C and the odds ratios for LDL-C goal attainment rates ( |
| doi_str_mv | 10.1016/j.jacl.2010.10.004 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_815964624</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1933287410003934</els_id><sourcerecordid>815964624</sourcerecordid><originalsourceid>FETCH-LOGICAL-c410t-4cbbc76fced29aff141073240948612c40136a3cb5d18ef384cab563380d2e693</originalsourceid><addsrcrecordid>eNp9Ustu1TAQjRCIlsIPsEDescqtX3ESCSGhqjykSiwKa8txJjcOjp3azq3u5_FnOL2FBUKsxjpzzlhnzhTFa4J3BBNxOe0mpe2O4gdghzF_UpyTphYlr5v2aX63jJW0qflZ8SLGCeOqqnH1vDijhFAqWnFe_Ly9N0mPxu3REPyMRrMfSxgGo5U-ImsW05fW30PYGGmEoBYDESWPopkPKiaVjEPK9Sizyh5cNOlB55fgE-SeHr2FmCB4i_ZeWaRSUsbN4BLa2j54p8IRjaBCQr2JoCJc_hsu4W41B2U37ZJ_zjW-LJ4NykZ49Vgviu8fr79dfS5vvn76cvXhptSc4FRy3XW6FoOGnrZqGEhGa0Y5bnkjCNUcEyYU013VkwYG1nCtukow1uCegmjZRfH2NDcbu1uzIzmbqMFa5cCvUTakagUXlGcmPTF18DEGGOQSzJzNSILllpyc5Jac3JLbsJxcFr15HL92M_R_JL-jyoR3JwJkkwcDQUadF5D9mAA6yd6b_89__5dcW-NyzPYHHCFOfg0ur08SGanE8na7ne10CMaYtYyzXyj4xWQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>815964624</pqid></control><display><type>article</type><title>Switching from high-efficacy lipid-lowering therapies to simvastatin and low-density lipoprotein cholesterol goal attainment in coronary heart disease/coronary heart disease-equivalent patients</title><source>Elsevier</source><creator>Tunceli, Kaan, PhD ; Sajjan, Shiva G., PhD ; Ramey, Dena R., BA ; Neff, David R., DO ; Tershakovec, Andrew M., MD, MPH ; Hu, X. Henry, MD, PhD ; Tomassini, Joanne E., PhD ; Foody, JoAnne M., MD</creator><creatorcontrib>Tunceli, Kaan, PhD ; Sajjan, Shiva G., PhD ; Ramey, Dena R., BA ; Neff, David R., DO ; Tershakovec, Andrew M., MD, MPH ; Hu, X. Henry, MD, PhD ; Tomassini, Joanne E., PhD ; Foody, JoAnne M., MD</creatorcontrib><description>Background The availability of generic simvastatin in 2006 has prompted substantial changes in formulary recommendations for lipid-management agents. Objective To assess the impact of switches from high-efficacy lipid-lowering therapy to simvastatin on low-density lipoprotein cholesterol (LDL-C) and goal attainment in coronary heart disease (CHD) or CHD risk-equivalent patients in a managed care setting. Methods In this retrospective observational study, we estimated the least squares mean difference in the percent change from baseline LDL-C and the odds ratios for LDL-C goal attainment rates (<100 mg/dL and <70 mg/dL) at follow-up for each baseline high-efficacy lipid-lowering therapy with the analysis of covariance and logistic regressions, respectively. Results We identified 18,061 patients who, between September 1, 2004 and October 31, 2008, were either switched from or remained on their initial high-efficacy LDL-C lowering therapy: ezetimibe/simvastatin fixed-dose combination (E/S), rosuvastatin, or atorvastatin. The difference in percent change in LDL-C levels from baseline were 25.2 (95% confidence interval 21.2−29.2), 13.0 (6.0−20.0), and 3.1 (0.3−5.9) greater in switchers to simvastatin in the E/S, rosuvastatin, and atorvastatin comparisons, respectively, after adjusting for age, sex, and starting dose of the initial therapy. For switchers, the percent of patients at LDL-C <100 mg/dL at follow-up decreased from 83.5% to 63.8% in the E/S, 67.7% to 52.7% in the rosuvastatin, and 65.1% to 60.2% in the atorvastatin cohorts. The percent of patients at LDL-C <70 mg/dL at follow-up was lower for all switcher groups compared with nonswitchers. Conclusions Among CHD/CHD risk-equivalent patients, switching to simvastatin was associated with increases in LDL-C levels and lower LDL-C goal attainment rates. The public health impact of this phenomenon on population risk and CHD events remains to be determined.</description><identifier>ISSN: 1933-2874</identifier><identifier>EISSN: 1876-4789</identifier><identifier>DOI: 10.1016/j.jacl.2010.10.004</identifier><identifier>PMID: 21122696</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Anticholesteremic Agents - therapeutic use ; Atorvastatin Calcium ; Azetidines - therapeutic use ; Cardiovascular ; Cardiovascular diseases ; Cholesterol ; Cholesterol, LDL - blood ; Coronary Disease - drug therapy ; Drug Therapy, Combination ; Ezetimibe ; Female ; Fluorobenzenes - therapeutic use ; Goal attainment ; Heptanoic Acids - therapeutic use ; Humans ; Lipoproteins ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Pyrimidines - therapeutic use ; Pyrroles - therapeutic use ; Retrospective Studies ; Rosuvastatin Calcium ; Simvastatin - therapeutic use ; Statin interventions ; Sulfonamides - therapeutic use</subject><ispartof>Journal of clinical lipidology, 2010-11, Vol.4 (6), p.491-500</ispartof><rights>National Lipid Association</rights><rights>2010 Elsevier Inc.</rights><rights>Copyright © 2010 National Lipid Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c410t-4cbbc76fced29aff141073240948612c40136a3cb5d18ef384cab563380d2e693</citedby><cites>FETCH-LOGICAL-c410t-4cbbc76fced29aff141073240948612c40136a3cb5d18ef384cab563380d2e693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21122696$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tunceli, Kaan, PhD</creatorcontrib><creatorcontrib>Sajjan, Shiva G., PhD</creatorcontrib><creatorcontrib>Ramey, Dena R., BA</creatorcontrib><creatorcontrib>Neff, David R., DO</creatorcontrib><creatorcontrib>Tershakovec, Andrew M., MD, MPH</creatorcontrib><creatorcontrib>Hu, X. Henry, MD, PhD</creatorcontrib><creatorcontrib>Tomassini, Joanne E., PhD</creatorcontrib><creatorcontrib>Foody, JoAnne M., MD</creatorcontrib><title>Switching from high-efficacy lipid-lowering therapies to simvastatin and low-density lipoprotein cholesterol goal attainment in coronary heart disease/coronary heart disease-equivalent patients</title><title>Journal of clinical lipidology</title><addtitle>J Clin Lipidol</addtitle><description>Background The availability of generic simvastatin in 2006 has prompted substantial changes in formulary recommendations for lipid-management agents. Objective To assess the impact of switches from high-efficacy lipid-lowering therapy to simvastatin on low-density lipoprotein cholesterol (LDL-C) and goal attainment in coronary heart disease (CHD) or CHD risk-equivalent patients in a managed care setting. Methods In this retrospective observational study, we estimated the least squares mean difference in the percent change from baseline LDL-C and the odds ratios for LDL-C goal attainment rates (<100 mg/dL and <70 mg/dL) at follow-up for each baseline high-efficacy lipid-lowering therapy with the analysis of covariance and logistic regressions, respectively. Results We identified 18,061 patients who, between September 1, 2004 and October 31, 2008, were either switched from or remained on their initial high-efficacy LDL-C lowering therapy: ezetimibe/simvastatin fixed-dose combination (E/S), rosuvastatin, or atorvastatin. The difference in percent change in LDL-C levels from baseline were 25.2 (95% confidence interval 21.2−29.2), 13.0 (6.0−20.0), and 3.1 (0.3−5.9) greater in switchers to simvastatin in the E/S, rosuvastatin, and atorvastatin comparisons, respectively, after adjusting for age, sex, and starting dose of the initial therapy. For switchers, the percent of patients at LDL-C <100 mg/dL at follow-up decreased from 83.5% to 63.8% in the E/S, 67.7% to 52.7% in the rosuvastatin, and 65.1% to 60.2% in the atorvastatin cohorts. The percent of patients at LDL-C <70 mg/dL at follow-up was lower for all switcher groups compared with nonswitchers. Conclusions Among CHD/CHD risk-equivalent patients, switching to simvastatin was associated with increases in LDL-C levels and lower LDL-C goal attainment rates. The public health impact of this phenomenon on population risk and CHD events remains to be determined.</description><subject>Adult</subject><subject>Aged</subject><subject>Anticholesteremic Agents - therapeutic use</subject><subject>Atorvastatin Calcium</subject><subject>Azetidines - therapeutic use</subject><subject>Cardiovascular</subject><subject>Cardiovascular diseases</subject><subject>Cholesterol</subject><subject>Cholesterol, LDL - blood</subject><subject>Coronary Disease - drug therapy</subject><subject>Drug Therapy, Combination</subject><subject>Ezetimibe</subject><subject>Female</subject><subject>Fluorobenzenes - therapeutic use</subject><subject>Goal attainment</subject><subject>Heptanoic Acids - therapeutic use</subject><subject>Humans</subject><subject>Lipoproteins</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Odds Ratio</subject><subject>Pyrimidines - therapeutic use</subject><subject>Pyrroles - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Rosuvastatin Calcium</subject><subject>Simvastatin - therapeutic use</subject><subject>Statin interventions</subject><subject>Sulfonamides - therapeutic use</subject><issn>1933-2874</issn><issn>1876-4789</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><recordid>eNp9Ustu1TAQjRCIlsIPsEDescqtX3ESCSGhqjykSiwKa8txJjcOjp3azq3u5_FnOL2FBUKsxjpzzlhnzhTFa4J3BBNxOe0mpe2O4gdghzF_UpyTphYlr5v2aX63jJW0qflZ8SLGCeOqqnH1vDijhFAqWnFe_Ly9N0mPxu3REPyMRrMfSxgGo5U-ImsW05fW30PYGGmEoBYDESWPopkPKiaVjEPK9Sizyh5cNOlB55fgE-SeHr2FmCB4i_ZeWaRSUsbN4BLa2j54p8IRjaBCQr2JoCJc_hsu4W41B2U37ZJ_zjW-LJ4NykZ49Vgviu8fr79dfS5vvn76cvXhptSc4FRy3XW6FoOGnrZqGEhGa0Y5bnkjCNUcEyYU013VkwYG1nCtukow1uCegmjZRfH2NDcbu1uzIzmbqMFa5cCvUTakagUXlGcmPTF18DEGGOQSzJzNSILllpyc5Jac3JLbsJxcFr15HL92M_R_JL-jyoR3JwJkkwcDQUadF5D9mAA6yd6b_89__5dcW-NyzPYHHCFOfg0ur08SGanE8na7ne10CMaYtYyzXyj4xWQ</recordid><startdate>201011</startdate><enddate>201011</enddate><creator>Tunceli, Kaan, PhD</creator><creator>Sajjan, Shiva G., PhD</creator><creator>Ramey, Dena R., BA</creator><creator>Neff, David R., DO</creator><creator>Tershakovec, Andrew M., MD, MPH</creator><creator>Hu, X. Henry, MD, PhD</creator><creator>Tomassini, Joanne E., PhD</creator><creator>Foody, JoAnne M., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201011</creationdate><title>Switching from high-efficacy lipid-lowering therapies to simvastatin and low-density lipoprotein cholesterol goal attainment in coronary heart disease/coronary heart disease-equivalent patients</title><author>Tunceli, Kaan, PhD ; Sajjan, Shiva G., PhD ; Ramey, Dena R., BA ; Neff, David R., DO ; Tershakovec, Andrew M., MD, MPH ; Hu, X. Henry, MD, PhD ; Tomassini, Joanne E., PhD ; Foody, JoAnne M., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c410t-4cbbc76fced29aff141073240948612c40136a3cb5d18ef384cab563380d2e693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anticholesteremic Agents - therapeutic use</topic><topic>Atorvastatin Calcium</topic><topic>Azetidines - therapeutic use</topic><topic>Cardiovascular</topic><topic>Cardiovascular diseases</topic><topic>Cholesterol</topic><topic>Cholesterol, LDL - blood</topic><topic>Coronary Disease - drug therapy</topic><topic>Drug Therapy, Combination</topic><topic>Ezetimibe</topic><topic>Female</topic><topic>Fluorobenzenes - therapeutic use</topic><topic>Goal attainment</topic><topic>Heptanoic Acids - therapeutic use</topic><topic>Humans</topic><topic>Lipoproteins</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Odds Ratio</topic><topic>Pyrimidines - therapeutic use</topic><topic>Pyrroles - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Rosuvastatin Calcium</topic><topic>Simvastatin - therapeutic use</topic><topic>Statin interventions</topic><topic>Sulfonamides - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tunceli, Kaan, PhD</creatorcontrib><creatorcontrib>Sajjan, Shiva G., PhD</creatorcontrib><creatorcontrib>Ramey, Dena R., BA</creatorcontrib><creatorcontrib>Neff, David R., DO</creatorcontrib><creatorcontrib>Tershakovec, Andrew M., MD, MPH</creatorcontrib><creatorcontrib>Hu, X. Henry, MD, PhD</creatorcontrib><creatorcontrib>Tomassini, Joanne E., PhD</creatorcontrib><creatorcontrib>Foody, JoAnne M., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of clinical lipidology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tunceli, Kaan, PhD</au><au>Sajjan, Shiva G., PhD</au><au>Ramey, Dena R., BA</au><au>Neff, David R., DO</au><au>Tershakovec, Andrew M., MD, MPH</au><au>Hu, X. Henry, MD, PhD</au><au>Tomassini, Joanne E., PhD</au><au>Foody, JoAnne M., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Switching from high-efficacy lipid-lowering therapies to simvastatin and low-density lipoprotein cholesterol goal attainment in coronary heart disease/coronary heart disease-equivalent patients</atitle><jtitle>Journal of clinical lipidology</jtitle><addtitle>J Clin Lipidol</addtitle><date>2010-11</date><risdate>2010</risdate><volume>4</volume><issue>6</issue><spage>491</spage><epage>500</epage><pages>491-500</pages><issn>1933-2874</issn><eissn>1876-4789</eissn><abstract>Background The availability of generic simvastatin in 2006 has prompted substantial changes in formulary recommendations for lipid-management agents. Objective To assess the impact of switches from high-efficacy lipid-lowering therapy to simvastatin on low-density lipoprotein cholesterol (LDL-C) and goal attainment in coronary heart disease (CHD) or CHD risk-equivalent patients in a managed care setting. Methods In this retrospective observational study, we estimated the least squares mean difference in the percent change from baseline LDL-C and the odds ratios for LDL-C goal attainment rates (<100 mg/dL and <70 mg/dL) at follow-up for each baseline high-efficacy lipid-lowering therapy with the analysis of covariance and logistic regressions, respectively. Results We identified 18,061 patients who, between September 1, 2004 and October 31, 2008, were either switched from or remained on their initial high-efficacy LDL-C lowering therapy: ezetimibe/simvastatin fixed-dose combination (E/S), rosuvastatin, or atorvastatin. The difference in percent change in LDL-C levels from baseline were 25.2 (95% confidence interval 21.2−29.2), 13.0 (6.0−20.0), and 3.1 (0.3−5.9) greater in switchers to simvastatin in the E/S, rosuvastatin, and atorvastatin comparisons, respectively, after adjusting for age, sex, and starting dose of the initial therapy. For switchers, the percent of patients at LDL-C <100 mg/dL at follow-up decreased from 83.5% to 63.8% in the E/S, 67.7% to 52.7% in the rosuvastatin, and 65.1% to 60.2% in the atorvastatin cohorts. The percent of patients at LDL-C <70 mg/dL at follow-up was lower for all switcher groups compared with nonswitchers. Conclusions Among CHD/CHD risk-equivalent patients, switching to simvastatin was associated with increases in LDL-C levels and lower LDL-C goal attainment rates. The public health impact of this phenomenon on population risk and CHD events remains to be determined.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>21122696</pmid><doi>10.1016/j.jacl.2010.10.004</doi><tpages>10</tpages></addata></record> |
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| subjects | Adult Aged Anticholesteremic Agents - therapeutic use Atorvastatin Calcium Azetidines - therapeutic use Cardiovascular Cardiovascular diseases Cholesterol Cholesterol, LDL - blood Coronary Disease - drug therapy Drug Therapy, Combination Ezetimibe Female Fluorobenzenes - therapeutic use Goal attainment Heptanoic Acids - therapeutic use Humans Lipoproteins Logistic Models Male Middle Aged Odds Ratio Pyrimidines - therapeutic use Pyrroles - therapeutic use Retrospective Studies Rosuvastatin Calcium Simvastatin - therapeutic use Statin interventions Sulfonamides - therapeutic use |
| title | Switching from high-efficacy lipid-lowering therapies to simvastatin and low-density lipoprotein cholesterol goal attainment in coronary heart disease/coronary heart disease-equivalent patients |
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