Trends of lipid-lowering drug utilization, treatment intensity and LDL-C target attainment in adults with diabetes and non-dialysis chronic kidney disease in Hong Kong
Yanting Huang , Aimin Yang , Mai Shi , Jiazhou Yu , Hongjiang Wu , Juliana N.M. Lui , Alice P.S. Kong , Ronald C.W. Ma , Andrea O.Y. Luk , Calvin Ke , Juliana C.N. Chan , Elaine Chow
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引用次数: 0
Abstract
Background
With evolving treatment targets, concerns over renal safety for some statins and new lipid-lowering drugs (LLDs), we aimed to evaluate the trends of statins and non-statin LLDs [ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i)] utilization in individuals with diabetes and non-dialysis chronic kidney disease (CKD) in Hong Kong.
Methods
We conducted a retrospective cohort study of 332,975 Chinese individuals with diabetes and non-dialysis CKD using data from Hong Kong Hospital Authority in 2002–2019. We analyzed the annual average dosage, treatment intensity (low-intensity: <30% Low density lipoprotein-cholesterol (LDL-C) reduction; moderate-intensity: 30%–49%; high-intensity: ≥50%) and attained LDL-C targets defined by annual average LDL-C value. We evaluated the age-sex standardized trends of statin and common non-statin LLD use for primary and secondary prevention across age, sex and CKD stages.
Findings
Statin-users increased from 17.6% in 2002 to 71.3% in 2019 with similar trends across age, sex and CKD stages G3–5 except for the 18–49 age group having the highest proportion of non-users of LLD (39%). By 2019, the usage of ezetimibe (1.19%) and PCSK9i (0.01%) remained low. Amongst statin-users, 27.2% received moderate-intensity therapy for primary prevention and 11.2% received high-intensity therapy for secondary prevention. In 2019, 33.3% of LLD-users achieved LDL-C < 1.8 mmol/L for primary prevention and 21.3% achieved LDL-C < 1.4 mmol/L for secondary prevention.
Interpretation
Despite the increasing use of statins, treatment gaps remain with respect to treatment intensity and LDL-C target attainment in diabetes and non-dialysis CKD calling for increased use of combination statin and ezetimibe or PCSK9i to close the treatment gaps.
Funding
Dr. Aimin Yang was supported by a CUHK Impact Research Fellowship Scheme.
期刊介绍:
The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.