An Evaluation of the Factors Associated with Statin Dose Management and Low-Density Lipoprotein-Cholesterol Goal Attainment
Setareh A. Williams
Gerald M. Borok
Purpose: To examine factors associated with HMG-CoA reductase inhibitor (statin) management and the effect of therapeutic modifications on patients' abilities to reach their low-density lipoprotein-cholesterol (LDL-C) goal in a sample of managed care enrollees. Methods: This retrospective analysis utilized electronic pharmacy claims, medical claims, and laboratory data, and explored the occurrence and magnitude of modifications to statin regimens. Patients aged >=18 years who were initiated on statin therapy between 1 January 2001 and 31 December 2001 and who were continuously enrolled for 6 months prior to and 12 months following the index prescription were included. A subgroup analysis incorporated laboratory data to determine whether patients attained their LDL-C treatment goal. Results: A total of 38_567 patients were identified: 50.6% were female and patients had a mean age of 63.6 +- 13.4 years. During a 1-year follow-up, 16.1% (n = 6220) had a modification to their statin regimen. Multivariate analysis showed that significant predictors of regimen modification included age, sex, index statin, index statin potency, and the occurrence of a cardiac reperfusion procedure or acute hospitalization during the 6-month pre-index period (p < 0.05). A subgroup of 254 patients with laboratory data was identified: 57.9% of these patients were female and their mean age was 66.6 +- 10.5 years. Of this cohort, only 14.2% had a modification to their statin regimen. Goal attainment was significantly more frequent among patients whose statin regimen was modified compared with patients whose statin regimen was not modified (72.2% vs 52.8%; p = 0.0294). Conclusion: The low occurrence of therapeutic modifications and goal attainment may indicate a need for greater awareness of the importance of effective statin use.
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