THE EFFECTIVENESS OF OUTPATIENT AND HOSPITAL LIPID-LOWERING THERAPY IN PATIENTS WITH HIGH AND VERY HIGH CARDIOVASCULAR RISK DURING 2011-2015

Aim. To estimate the effectiveness of lipid-lowering therapy (LLT) at outpatient and hospital treatment stages in patients at high and very high cardiovascular risk during 2011-2015.

Material and methods. In a cross-sectional epidemiological study we analyzed LLT in hospital patients for the period April-May 2011, 2012 and 2015. All data were obtained from randomly selected case-records of patients (n=548; 20% of all hospital patients over the study period). Risk categories of patients as well as target levels of low density lipoprotein (LDL) cholesterol were determined according to the current clinical guidelines for the respective year. Outpatient LLT was administered in local out-patient clinics and hospital one – in the clinic of State Research Centre for Preventive Medicine.

Results. The most commonly prescribed group of lipid-lowering drugs was statins, while combined treatment or monotherapy with other lipid-lowering agents were used only in rare cases. From 2011 to 2015 the proportion of patients taking statins before admission increased from 20% to 49.8% (from 23.1% up to 29.6% of patients at high cardiovascular risk and from 28% up to 68.5% of patients at very high cardiovascular risk, respectively). During hospitalization the proportion of individuals receiving statins increased from 49.8% to 72.9%, from 29.6% to 74% and from 68.5% to 95.3% in general group, among patients at high and very high cardiovascular risk, respectively. In 2015 LDL cholesterol target levels were achieved in 14.8% and 7.1% of patients at high and very high risk, respectively. In-hospital rate of simvastatin administration reduced from 33.6% to 0.5%, whereas prescription of atorvastatin and rosuvastatin increased from 31.4% to 64.5% and from 3.6% to 9.9%, respectively. Average dose of statins (in conversion to atorvastatin) increased from 10 mg to 20 mg in high-risk patients and from 10 mg to 40 mg – in very high risk group.

Conclusion. Positive trend in frequency of LLT prescription was demonstrated in patients at high and very high cardiovascular risk during 2011-2015. Nevertheless, significant number of patients in out-patient clinics still remains under non-optimal treatment. 

1. Boytsov SA, Khomitskaya YuV. Centralised Survey on the Undertreatment of the Hypercholesterolemia in Russia (CEPHEUS). Kardiovaskulyarnaya Terapiya i Profilaktika. 2013;12 (4):67-74 (In Russian) [Бойцов С.А., Хомицкая Ю.В. Централизованное исследование по оценке эффективности лечения гиперхолестеринемии в России (CEPHEUS). Кардиоваскулярная Терапия иПрофилактика. 2013;12 (4):67-74).

2. Oganov RG, Kukharchuk VV, Arutyunov GP, et al. Persistent dyslipidemia in statin-treated patients: Russian real-world clinical practice data (Russian part of the DYSIS Study). J. Kardiovaskulyarnaya Terapiya i Profilaktika. 2012;12(4):70-8 (In Russian) [Оганов Р.Г., Кухарчук В.В., Арутюнов Г.П. и др. Сохраняющиеся нарушения показателей липидного спектра у пациентов с дислипидемией, получающих статины, в реальной клинической практике в российской федерации (российская часть исследования DYSIS). Кардиоваскулярная Терапия и Профилактика. 2012;12(4):70-8].

3. Susekov AV, Zubarevа MYu, Deev AD, et al. Main results Moscow research on statins (Moscow Statin Survey, MSS). Serdtse. 2006;5,6(30):324-8 (In Russian) [Сусеков А.В., Зубарева М.Ю., Деев А.Д., и др. Основные результаты Московского исследования по статинам (Moscow Statin Survey, MSS). Сердце. 2006;5,6(30):324-8].

4. Chiang CE, Ferrières J, Gotcheva NN, et al. Suboptimal Control of Lipid Levels: Results from 29 Countries Participating in the Centralized Pan-Regional Surveys on the Undertreatment ofHypercholesterolaemia (CEPHEUS). J Atheroscler Thromb. 2015;22:567-87.

5. Goodman SG, Langer A, Bastien NR, et al. Prevalence of dyslipidemia in statin-treated patients in Canada: results of the DYSlipidemia International Study (DYSIS). Can J Cardiol. 2010;26(9):e330-5.

6. Al Sifri SN, Almahmeed W, Azar S, et al. Results of the Dyslipidemia International Study (DYSIS)-Middle East: clinical perspective on the prevalence and characteristics of lipid abnormalities in the setting of chronic statin treatment. PLoS One. 2014;9(1):e 84350.

7. Kukharchuk VV., Aksenov VA, Aronov DM, et al. National guidelines for diagnosis and correction of disorders of lipid metabolism in order to prevent and treat atherosclerosis. Kardiovaskulyarnaya Terapiya i Profilaktika. 2007;6(6) suppl 3:1-32 (In Russian) [Кухарчук В.В., Аксенов В.А., Аронов Д.М., Национальные рекомендации по диагностике и коррекции нарушений липидного обмена с целью профилактики и лечения атеросклероза. Кардиоваскулярная Терапия иПрофилактика. 2007;6(6) Приложение 3:1-32].

8. Catapano AL, Reiner Z, De Backer G, et al. ESC/EAS Guidelines for the management of dyslipidaemias. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). J Atherosclerosis. 2011;217(1):3-46.

9. Ballantyne CM, Blazing MA, King TR, et al. Efficacy and safety of ezetimibe co-administered with simvastatin compared with atorvastatin in adults with hypercholesterolemia. Am J Cardiol. 2004;93:148794.

10. Akhmedzhanov NM, Nebieridze DV, Safaryan AS, et al. Analysis of hypercholesterolemia prevalence in the outpatient practice (according to the ARGO study): Part I. Rational Pharmacotherapy in Cardiology. 2015;11(3):253-260. (In Russ.) [Ахмеджанов Н.М., Небиеридзе Д.В., Сафарян А.С. и др. Анализ распространенности гиперхолестеринемии в условиях амбулаторной практики (по данным исследования АРГО): ЧАСТЬ I. Рациональная Фармакотерапия в Кардиологии. 2015;11(3):253-60].

11. Ershova AI, Meshkov AN, Yakushin SS, et al. Diagnosis and treatment of patients with severe hypercholesterolemia in real outpatient practice (according to the RECVASAregistry). Rational Pharmacotherapy in Cardiology. 2014;10(6):612-616. (In Russ.) [Ершова А.И., Мешков А.Н., Якушин С.С., и др. Диагностика и лечение больных с выраженной гиперхолестеринемией в реальной амбулаторнополиклинической практике (по данным регистра РЕКВАЗА). Рациональная Фармакотерапия в Кардиологии. 2014;10(6):612-6].

12. Meshkov AN. Lipid-lowering efficacy of rosuvastatin compared with other statins. Rational Pharmacotherapy in Cardiology. 2012;8(5):691-693. (In Russ.) [Мешков А.Н. Гиполипидемическая эффективность розувастатина в сравнении с другими статинами. Рациональная Фармакотерапия в Кардиологии. 2012;8(5):691-3].