Lipid-lowering drug prescriptions in a group of Colombian patients
Abstract
Introduction. Lipid-lowering drugs, especially statins, have shown great relevance in preventing and treating cardiovascular diseases.
Objective. To determine the prescription patterns of lipid-lowering drugs and the variables associated with their use in a Colombian population.
Materials and methods. This is a cross-sectional descriptive study. From a drug dispensing database of approximately 4.5 million Colombian health system affiliates, patients of all ages and both sexes treated with lipid-lowering agents (statins, fibrates, ezetimibe) were identified between January and March, 2017. Demographic, pharmacological and co-medication variables were included.
Results. In total, 103,624 patients were identified as being treated with lipid-lowering agents. The average age was 67.5 years, and 49.8% were 65 years or older. Women comprised 58.0% of the patients. Statins were the most used (n=96,910; 93.5%), and atorvastatin (n=80,812; 78.0%) and lovastatin (n=12,621; 12.2%) were the most frequent. The mean atorvastatin dose was 30.3 mg/day, and 49.9% of its users received presentations of 40 mg or more. A total of 9,258 (8.9%) patients received fibrates, and only 780 (0.8%) were taking ezetimibe. Of this population, 94.9% were treated with lipid-lowering monotherapy, and 97.3% (n=100,813) had co-medication for their comorbidities, with the most frequent being antihypertensive (89.1%), antiplatelet (57.8%), antidiabetic (31.5%) and antiulcerative agents (34.2%).
Conclusions. Atorvastatin is currently the most frequently used lipid-lowering drug in this group of Colombian patients, especially in monotherapy and at doses close to the defined daily dose. Only half received high-intensity doses. New studies are required to verify the efficacy of these therapies.
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References
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095-128. https://doi.org/10.1016/s0140-6736(12)61728-0
Ministerio de Salud y Protección Social. Análisis de situación de salud (ASIS). Colombia, 2016. Accessed: January 7, 2017. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/ED/PSP/asis-colombia-2016.pdf
Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, et al. American Association of Clinical Endocrinologists and American College of Endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocr Pract. 2017;23:1-87. https://doi.org/10.4158/EP171764.APPGL
Turner GM, Calvert M, Feltham MG, Ryan R, Fitzmaurice D, Cheng KK, et al. Underprescribing of prevention drugs and primary prevention of stroke and transient ischaemic attack in UK general practice: A retrospective analysis. PLoS Med. 2016;13:e1002169. https://doi.org/10.1371/journal.pmed.1002169
Kulenovic I, Mortensen MB, Bertelsen J, May O, Dodt KK, Kanstrup H, et al. Statin use prior to first myocardial infarction in contemporary patients: Inefficient and not gender equitable. Prev Med. 2016;83:63-9. https://doi.org/10.1016/j.ypmed.2015.12.001
Machado JE, Moncada JC, Mesa G. Prescription patterns for antilipidemic drugs in a group of Colombian patients. Rev Panam Salud Pública. 2008;23:179-87.
Machado-Alba JE, Murillo-Muñoz MM, Machado-Duque ME. Effectiveness of lipid-lowering therapy among a sample of patients in Colombia. Rev Panam Salud Pública. 2013;33:383-90.
Machado-Alba JE, Machado-Duque ME, Yepes MC, Manrique S, Tobón LM. Tratamiento hipolipemiante y su efectividad en pacientes de cuatro ciudades colombianas. Acta Med Colomb. 2016;41:181-6.
Machado-Alba JE, Torres D, Portilla A, Ruiz AF. Results of the inclusion of new medications in the obligatory health system plan in Colombia, 2012-2013. Value Health Reg Issues. 2015;8:28-35. https://doi.org/10.1016/j.vhri.2015.02.002
Machado-Alba JE, Machado-Duque ME. Prevalencia de factores de riesgo cardiovascular en pacientes con dislipidemia afiliados al sistema de salud en Colombia. Rev Peru Med Exp Salud Pública. 2013;30:205-11.
Rodríguez F, Maron DJ, Knowles JW, Virani SS, Lin S, Heidenreich PA. Association between intensity of statin therapy and mortality in patients with atherosclerotic cardiovascular disease. JAMA Cardiol. 2017;2:47-54. https://doi.org/10.1001/jamacardio.2016.4052
US Preventive Services Task Force, Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW Jr, et al. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2016;316:1997-2007. https://doi.org/10.1001/jama.2016.15450
Muñoz O, García ÁA, Fernández DG, Higuera AM, Ruiz ÁJ, Aschner P, et al. Guía de práctica clínica para la prevención, detección temprana, diagnóstico, tratamiento y seguimiento de las dislipidemias: tratamiento farmacológico con estatinas. Rev Colomb Cardiol. 2015;22:14-21. https://doi.org/10.1016/j.rccar.2015.02.001
Rosselli D, Castaño N, Arciniegas J-A, García ÁA, Muñoz Ó-M, Gómez-Restrepo C. Costeffectiveness of statins for the treatment of dyslipidemia in Colombia. Acta Med Colomb. 2015;40:118-24.
Hsieh HC, Hsu JC, Lu CY. 10-year trends in statin utilization in Taiwan: A retrospective study using Taiwan’s National Health Insurance Research Database. BMJ Open. 2017;7:e014150. https://doi.org/10.1136/bmjopen-2016-014150
Ferrajolo C, Arcoraci V, Sullo MG, Rafaniello C, Sportiello L, Ferrara R, et al. Pattern of statin use in southern italian primary care: Can prescription databases be used for monitoring long-term adherence to the treatment? PLoS One. 2014;9:e102146. https://doi.org/10.1371/journal.pone.0102146
Cunico C, Picheth G, Correr CJ, Scartezini M. Assessing the adherence to and the therapeutic effectiveness of hypolipidemic agents in a population of patients in Brazil: A retrospective cohort study. Pharm Pract (Granada). 2014;12:378.
Ferrières J, Gousse ET-L, Fabry C, Hermans MP. Assessment of lipid-lowering treatment in France – The CEPHEUS study. Arch Cardiovasc Dis. 2008;101:557-63. https://doi.org/:10.1016/j.acvd.2008.08.006
Enger C, Gately R, Ming EE, Niemcryk SJ, Williams L, McAfee AT. Pharmacoepidemiology safety study of fibrate and statin concomitant therapy. Am J Cardiol. 2010;106:1594-601. https://doi.org/10.1016/j.amjcard.2010.07.041
Fievet C, Staels B. Combination therapy of statins and fibrates in the management of cardiovascular risk. Curr Opin Lipidol. 2009;20:505-11. https://doi.org/10.1097/MOL.0b013e328332e9ef
Tenenbaum A, Fisman EZ, Motro M, Adler Y. Optimal management of combined dyslipidemia: What have we behind statins monotherapy? Adv Cardiol. 2008;45:127-53. https://doi.org/10.1159/0000115192
Pauff BR, Jiroutek MR, Holland MA, Sutton BS. Statin prescribing patterns: An analysis of data from patients with diabetes in the National Hospital Ambulatory Medical Care Survey Outpatient Department and National Ambulatory Medical Care Survey Databases, 2005-2010. Clin Ther. 2015;37:1329-39. https://doi.org/10.1016/j.clinthera.2015.03.020
Machado-Alba J, Fernández A, Castrillón JD, Campo CF, Echeverri LF, Gaviria A, et al. Prescribing patterns and economic costs of proton pump inhibitors in Colombia. Colomb Med. 2013;44:13-8.
Lin Wu FL, Wang J, Ho W, Chou CH, Wu YJ, Choo DW, et al. Effectiveness of a combination of ezetimibe and statins in patients with acute coronary syndrome and multiple comorbidities: A 6-year population-based cohort study. Int J Cardiol. 2017;233:43-51. https://doi.org/10.1016/j.ijcard.2017.02.006
Wallach-Kildemoes H, Hansen EH. Sociodemographic and diagnostic characteristics of prescribing a second-line lipid-lowering medication: Ezetimibe used as initial medication, switch from statins, or add-on medication. Eur J Clin Pharmacol. 2015;71:1245-54. https://doi.org/10.1007/s00228-015-1907-y
Sinnott C, Hugh SM, Boyce MB, Bradley CP. What to give the patient who has everything? A qualitative study of prescribing for multimorbidity in primary care. Br J Gen Pract. 2015;65:e184-91. https://doi.org/10.3399/bjgp15X684001
Juanes VG, Villar MC, González SF, Gómez JA, Alcántara MC, de Marino Gómez-Sandoval M, et al. Análisis del consumo de medicamentos utilizando indicadores de calidad en la prescripción. Aten Primaria. 2000;25:618-24.
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