- Email: [email protected]
Shifts in Dyslipidemia Clinical Guidelines: Do they Affect Disease Management and Prescribing Patterns?*
Abstracts reduced an average of 42mg/dL, with 36% of patients attaining a reduction of 30% or more from baseline. Non HDL-C goals were met in 69 patients. Conclusions: Referrals to a cardiology office based lipid clinic represent a diverse group. Half presented for primary prevention, the others for complex lipid disorders, many of whom were statin intolerant and have compliance challenges. Referral to a clinical lipid specialist resulted in an additional reduction in Non HDL-C. Due to the limited scope of the guidelines, lipid clinics play a vital and effective role in managing complex patients and serve as a resource for primary prevention.
138 Baseline Lipid Profiles and Statin Use among Patients with Atherosclerotic Cardiovascular Disease Peter P. Toth, MD, PhD, Xuehua Ke, PhD, Zhenxiang Zhao, PhD, Nicole Bonine, PhD, MPH, Mark Cziraky, PharmD, FAHA, Michael Grabner, PhD, John Barron, PharmD, Ralph Quimbo, MA, Debra Wertz, PharmD, Diane Flickinger, BSPharm, MBA, Burkhard Vangerow, MD, Thomas Power, MD, FACC, MRCPI, (Sterling, IL)
Lead Author’s Financial Disclosures: Dr. Toth has served on the speakers bureau for Amarin, AstraZeneca, Genzyme, GSK, Kowa, and Merck. He was a consultant for Amgen, AstraZeneca, Atherotech, Kowa, LipoScience, Merck, and Novartis. He served as a clinical expert for this study, under contract with HealthCore Inc. Study Funding: This study was funded by Eli Lilly and Company. Background/Synopsis: Numerous clinical trials have established that lowering of low density lipoprotein cholesterol (LDL-C) level reduces the risk of first and recurrent cardiovascular events. This study explored baseline lipid profiles and statin use among atherosclerotic cardiovascular disease (ASCVD) patients, as defined by the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, in a real-world environment. Objective/Purpose: To examine baseline LDL-C and high density lipoprotein cholesterol (HDL-C) levels and statin use among all ASCVD patients and stratified by history of ASCVD. Methods: This retrospective cohort study utilized claims and linked laboratory result data from the HealthCore Integrated Research Database (HIRD) to identify prevalent ASCVD patients over a one-year period (index date5first claim with ASCVD diagnosis in 2007). Patients had $ 12 months pre-index health plan enrollment and valid baseline LDL-C and HDL-C values. Descriptive statistics were used to examine LDL-C (categorized as ,70, 70-99, 100-129, $130 mg/dL), HDL-C (categorized as ,40, 40-59, $60 mg/dL) and statin use at baseline in all patients and patients with and without history of ASCVD.
441
Results: Among 55,256 ASCVD patients identified, at baseline, 64.8% had prior claims for ASCVD, 15.7% had high-intensity statin fills, 49.8% moderate/low-intensity statin fills only, 34.5% no statin fills, 60.1% LDL-C,100 mg/dL, 22.2% LDL-C,70 mg/dL, 26.4% HDL-C,40 mg/ dL, and 19.4% HDL-C $60 mg/dL. Among patients with prior ASCVD (n535,822), at baseline, 19.2% had highintensity statin fills, 53.3% moderate/ low-intensity statin fills only, 27.5% no statin fills, 67.6% LDL-C,100 mg/dL, 26.8% LDL-C,70 mg/dL, 27.8% HDL-C,40 mg/dL, and 17.9% HDL-C $60 mg/dL. Among patients without prior ASCVD (n519,434), at baseline, 9.4% had high-intensity statin fills, 43.2% moderate/ low-intensity statin fills only, 47.5% no statin fills, 75.9% LDL-C,130 mg/dL, 46.3% LDL-C,100 mg/dL, 13.9% LDL-C,70 mg/dL, 23.7% HDL-C,40 mg/dL, and 22.3% HDL-C $60 mg/dL. Conclusions: Results indicate that despite receipt of statins and adherence to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines on LDL-C goal attainment, new and recurrent ASCVD events were not uncommon. These findings may provide further support for recent ACC/AHA guideline recommendations toward use of high-intensity statins and additional management to reduce cardiovascular risk among ASCVD patients.
139 Shifts in Dyslipidemia Clinical Guidelines: Do they Affect Disease Management and Prescribing Patterns?* Courtney Murphy, PharmD, (New York, NY)
Lead Author’s Financial Disclosures: None Study Funding: None Background/Synopsis: Clinical guidelines dictate prescribing practices of healthcare providers. Constant review and revision of these clinical guidelines are necessary to provide optimal patient care, disease prevention, and reduction risk. With several modifications to treatment guidelines of dyslipidemia by various accredited bodies, we aimed to assess the challenges in treating patients based on the differing practice recommendations. A skillfully designed survey will be sent to healthcare providers of several different disciplines throughout the Mount Sinai Health System to determine shifts in prescribing patterns and guideline opinions of practitioner’s throughout a large health system. The study ‘‘Shifts in Dyslipidemia Clinical Guidelines: Do They Affect Disease Management and Prescribing Patterns?’’ surveys healthcare providers to assess the consistency in the use of lipid-lowering agents. More specifically, we are evaluating use of HMG-CoA reductase inhibitors, for prevention and treatment of dyslipidemia among our patient population based on the recommendations of the various guidelines in circulation.
442
Objective/Purpose: The aim of this study is to generate an observation concerning the relationship of individual prescriber perspectives towards dyslipidemia recommendations and the effect it has on the guidelines they utilize. Methods: The study will include a wide range of prescribing participants from physicians to nurse practitioners. Participants will be requested to complete a short online survey based on the Mount Sinai intranet server. Participants will be sent a link to the survey via their ‘‘chpnet.org’’ work email address. After clicking the link and filling out survey the Mount Sinai Web source will be responsible for gathering the survey responses and sending them to the primary investigator. The hospital server does not collect identifying information such as: names, email addresses, or IP addresses. This will ensure that participants remain anonymous. Results: The study is still accepting and reviewing data. Results are not currently available. Conclusions: The goal of this investigation is to determine if there is a relationship between the relationship of individual prescriber perspectives towards dyslipidemia recommendations and the effect it has on the guidelines they utilize. In the future the proposed study will make the following contributions to the field of medicine: Establish trends in clinical judgment based on various guidelines. Knowledge in understanding the key differences in dyslipidemia guidelines.
140 Effect of Duration of Statin Treatment on all Cause Mortality: A Meta-Analysis of Randomized Control Trials* Parasuram Krishnamoorthy, MD, Saurav Chatterjee, MD, Aakash Garg, MD, Jacob A. Udell, MD, MPH, Dharam J. Kumbhani, MD, FACC, FAHA, Jay S. Giri, MD, MPH, Debabrata Mukherjee, MD, FACC, (Englewood, NJ)
Lead Author’s Financial Disclosures: None
Journal of Clinical Lipidology, Vol 9, No 3, June 2015
Study Funding: None Background/Synopsis: Current guidelines recommend lifetime use of statins once initiated although most of the trials report a fairly short average follow-up time. Objective/Purpose: To determine the effect of duration of statin therapy on all cause mortality (ACM). Methods: A systematic review of randomized control trials in MEDLINE, EMBASE, EBSCO, CINAHL, Web of Science and Cochrane databases comparing statin use with placebo was performed. Trial level data including number of patients, clinical outcomes and duration of statin treatment were extracted. Primary outcome of interest was ACM. All trials comparing statin treatment versus placebo only were included for analysis. Studies were divided into two groups depending on the treatment duration (less than or equal to two years and more than two years). Random effects model was used to pool event rates and results were expressed as risk ratios with 95% confidence intervals. We assessed the heterogeneity between trials using the Higgins I2 statistic. Results: A total of 86 studies were identified out of which 26 studies with 120,649 patients were included for ACM analysis after exclusion criteria. Statin treatment overall was associated with reduction in ACM (Spearman’s rho 0.59, p50.001; [n526; 0.94 (0.89-0.99)]). Interestingly, subgroup analysis of statin treatment duration showed significant reduction in ACM only with less than two years of statin therapy [n511; 0.86 (0.76-0.98)] whereas more than two years of statin use was not associated with significant decrease in ACM [n515; 0.96 (0.91-1.01)]. There was insignificant heterogeneity between studies (I2510.6%;p50.32). Conclusions: Statin treatment for less than or equal to two years only was associated with decreased ACM. In the era of the current statin guidelines, detailed cost-benefits analyses will be required in different sub-groups to ascertain optimal clinical benefits.
138 Baseline Lipid Profiles and Statin Use among Patients with Atherosclerotic Cardiovascular Disease Peter P. Toth, MD, PhD, Xuehua Ke, PhD, Zhenxiang Zhao, PhD, Nicole Bonine, PhD, MPH, Mark Cziraky, PharmD, FAHA, Michael Grabner, PhD, John Barron, PharmD, Ralph Quimbo, MA, Debra Wertz, PharmD, Diane Flickinger, BSPharm, MBA, Burkhard Vangerow, MD, Thomas Power, MD, FACC, MRCPI, (Sterling, IL)
Lead Author’s Financial Disclosures: Dr. Toth has served on the speakers bureau for Amarin, AstraZeneca, Genzyme, GSK, Kowa, and Merck. He was a consultant for Amgen, AstraZeneca, Atherotech, Kowa, LipoScience, Merck, and Novartis. He served as a clinical expert for this study, under contract with HealthCore Inc. Study Funding: This study was funded by Eli Lilly and Company. Background/Synopsis: Numerous clinical trials have established that lowering of low density lipoprotein cholesterol (LDL-C) level reduces the risk of first and recurrent cardiovascular events. This study explored baseline lipid profiles and statin use among atherosclerotic cardiovascular disease (ASCVD) patients, as defined by the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, in a real-world environment. Objective/Purpose: To examine baseline LDL-C and high density lipoprotein cholesterol (HDL-C) levels and statin use among all ASCVD patients and stratified by history of ASCVD. Methods: This retrospective cohort study utilized claims and linked laboratory result data from the HealthCore Integrated Research Database (HIRD) to identify prevalent ASCVD patients over a one-year period (index date5first claim with ASCVD diagnosis in 2007). Patients had $ 12 months pre-index health plan enrollment and valid baseline LDL-C and HDL-C values. Descriptive statistics were used to examine LDL-C (categorized as ,70, 70-99, 100-129, $130 mg/dL), HDL-C (categorized as ,40, 40-59, $60 mg/dL) and statin use at baseline in all patients and patients with and without history of ASCVD.
441
Results: Among 55,256 ASCVD patients identified, at baseline, 64.8% had prior claims for ASCVD, 15.7% had high-intensity statin fills, 49.8% moderate/low-intensity statin fills only, 34.5% no statin fills, 60.1% LDL-C,100 mg/dL, 22.2% LDL-C,70 mg/dL, 26.4% HDL-C,40 mg/ dL, and 19.4% HDL-C $60 mg/dL. Among patients with prior ASCVD (n535,822), at baseline, 19.2% had highintensity statin fills, 53.3% moderate/ low-intensity statin fills only, 27.5% no statin fills, 67.6% LDL-C,100 mg/dL, 26.8% LDL-C,70 mg/dL, 27.8% HDL-C,40 mg/dL, and 17.9% HDL-C $60 mg/dL. Among patients without prior ASCVD (n519,434), at baseline, 9.4% had high-intensity statin fills, 43.2% moderate/ low-intensity statin fills only, 47.5% no statin fills, 75.9% LDL-C,130 mg/dL, 46.3% LDL-C,100 mg/dL, 13.9% LDL-C,70 mg/dL, 23.7% HDL-C,40 mg/dL, and 22.3% HDL-C $60 mg/dL. Conclusions: Results indicate that despite receipt of statins and adherence to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines on LDL-C goal attainment, new and recurrent ASCVD events were not uncommon. These findings may provide further support for recent ACC/AHA guideline recommendations toward use of high-intensity statins and additional management to reduce cardiovascular risk among ASCVD patients.
139 Shifts in Dyslipidemia Clinical Guidelines: Do they Affect Disease Management and Prescribing Patterns?* Courtney Murphy, PharmD, (New York, NY)
Lead Author’s Financial Disclosures: None Study Funding: None Background/Synopsis: Clinical guidelines dictate prescribing practices of healthcare providers. Constant review and revision of these clinical guidelines are necessary to provide optimal patient care, disease prevention, and reduction risk. With several modifications to treatment guidelines of dyslipidemia by various accredited bodies, we aimed to assess the challenges in treating patients based on the differing practice recommendations. A skillfully designed survey will be sent to healthcare providers of several different disciplines throughout the Mount Sinai Health System to determine shifts in prescribing patterns and guideline opinions of practitioner’s throughout a large health system. The study ‘‘Shifts in Dyslipidemia Clinical Guidelines: Do They Affect Disease Management and Prescribing Patterns?’’ surveys healthcare providers to assess the consistency in the use of lipid-lowering agents. More specifically, we are evaluating use of HMG-CoA reductase inhibitors, for prevention and treatment of dyslipidemia among our patient population based on the recommendations of the various guidelines in circulation.
442
Objective/Purpose: The aim of this study is to generate an observation concerning the relationship of individual prescriber perspectives towards dyslipidemia recommendations and the effect it has on the guidelines they utilize. Methods: The study will include a wide range of prescribing participants from physicians to nurse practitioners. Participants will be requested to complete a short online survey based on the Mount Sinai intranet server. Participants will be sent a link to the survey via their ‘‘chpnet.org’’ work email address. After clicking the link and filling out survey the Mount Sinai Web source will be responsible for gathering the survey responses and sending them to the primary investigator. The hospital server does not collect identifying information such as: names, email addresses, or IP addresses. This will ensure that participants remain anonymous. Results: The study is still accepting and reviewing data. Results are not currently available. Conclusions: The goal of this investigation is to determine if there is a relationship between the relationship of individual prescriber perspectives towards dyslipidemia recommendations and the effect it has on the guidelines they utilize. In the future the proposed study will make the following contributions to the field of medicine: Establish trends in clinical judgment based on various guidelines. Knowledge in understanding the key differences in dyslipidemia guidelines.
140 Effect of Duration of Statin Treatment on all Cause Mortality: A Meta-Analysis of Randomized Control Trials* Parasuram Krishnamoorthy, MD, Saurav Chatterjee, MD, Aakash Garg, MD, Jacob A. Udell, MD, MPH, Dharam J. Kumbhani, MD, FACC, FAHA, Jay S. Giri, MD, MPH, Debabrata Mukherjee, MD, FACC, (Englewood, NJ)
Lead Author’s Financial Disclosures: None
Journal of Clinical Lipidology, Vol 9, No 3, June 2015
Study Funding: None Background/Synopsis: Current guidelines recommend lifetime use of statins once initiated although most of the trials report a fairly short average follow-up time. Objective/Purpose: To determine the effect of duration of statin therapy on all cause mortality (ACM). Methods: A systematic review of randomized control trials in MEDLINE, EMBASE, EBSCO, CINAHL, Web of Science and Cochrane databases comparing statin use with placebo was performed. Trial level data including number of patients, clinical outcomes and duration of statin treatment were extracted. Primary outcome of interest was ACM. All trials comparing statin treatment versus placebo only were included for analysis. Studies were divided into two groups depending on the treatment duration (less than or equal to two years and more than two years). Random effects model was used to pool event rates and results were expressed as risk ratios with 95% confidence intervals. We assessed the heterogeneity between trials using the Higgins I2 statistic. Results: A total of 86 studies were identified out of which 26 studies with 120,649 patients were included for ACM analysis after exclusion criteria. Statin treatment overall was associated with reduction in ACM (Spearman’s rho 0.59, p50.001; [n526; 0.94 (0.89-0.99)]). Interestingly, subgroup analysis of statin treatment duration showed significant reduction in ACM only with less than two years of statin therapy [n511; 0.86 (0.76-0.98)] whereas more than two years of statin use was not associated with significant decrease in ACM [n515; 0.96 (0.91-1.01)]. There was insignificant heterogeneity between studies (I2510.6%;p50.32). Conclusions: Statin treatment for less than or equal to two years only was associated with decreased ACM. In the era of the current statin guidelines, detailed cost-benefits analyses will be required in different sub-groups to ascertain optimal clinical benefits.