The impact of lipid-lowering treatment patterns on LDL-C reduction and goal attainment in secondary prevention in Germany

Background

Information on lipid-lowering treatment (LLT) patterns (statin titration, statin switching, combination therapy and no change) in clinical practice is limited. The objectives of this study were to (i) characterize LLT patterns, (ii) explore variables that influence choice of aggressive initial and subsequent statin regimens and (iii) evaluate the impact of LLT patterns on LDL-C reduction and goal attainment.

Design

Randomly drawn patients who were newly initiated on statin (n = 603) from 62 randomly selected practices were retrospectively evaluated for a median of 3.9 years between 1998 and 2002.

Methods

Logistic regression, Cox model, t-test and GLM were used in the analyses. All tests of statistical significance were two-sided with α = 0.05.

Results

Both patient- and physician-related variables were important in the choice of initial and subsequent statin regimens. Patients initiated on LLT after revascularization were more likely to receive a high potency statin both initially and during subsequent changes. LDL-C levels influenced the choice of aggressive regimen. Switches to an aggressive regimen (68%) occurred in the first two years of therapy. Patients with more cardiac-related prescriptions at baseline had greater prescription persistence. Despite aggressive regimen changes, relatively few patients attained the target LDL-C of 100 mg/dL; nor was the reduction significantly different from that of the non-switched group.

Conclusion

Current statinmonotherapy-dominated LLT in Germany failed to get the majority of patients to recommended LDL-C goal of <100 mg/dL. Improved lipid management strategies are required so that patients on LLT get the necessary reductions in LDL-C and the benefits of projected reductions in CVD morbidity and mortality.