Vol 24, No 3 (2017)
Original articles — Clinical cardiology
Published online: 2017-04-10

open access

Page views 1187
Article views/downloads 1138
Get Citation

Connect on Social Media

Connect on Social Media

How has the treatment of hypercholesterolemia in Poland changed over the last six years?

Agnieszka Kapłon-Cieślicka1, Marcin Michalak1, Łukasz Kołtowski1, Krzysztof J. Filipiak1
Pubmed: 28394011
Cardiol J 2017;24(3):266-275.

Abstract

Background: To assess changes in the treatment of hypercholesterolemia in Polish ambulatory care over the last 6 years.

Methods: Data were obtained from two separate questionnaire-based studies, conducted in 2009 and 2015. The analysis included only those patient visits, which were associated with modifications of previous hypercholesterolemia treatment (1924 visits from the year 2009 and 1888 visits from the year 2015).

Results: In the present registry, there was a 19 mg/dL reduction in the level of total cholesterol and a 17 mg/dL reduction in the level of low-density lipoprotein compared to year 2009. In both registries, the most common reason for treatment modification was failure to achieve therapeutic goals. Compared to year 2009, there was an increase in the proportion of patients treated with atorvastatin and a reduction in the proportion of patients treated with simvastatin at baseline; additionally, in year 2015, 10% of patients received rosuvastatin. After therapy modification, there was a similar increase in the proportion of patients treated with a statin-fibrate combination in both registries. However, at present, ezetimibe was significantly less often added to previous therapy. In both registries, therapy modification led to an increase in the mean doses of the most commonly used statins, although presently, this increase was smaller than in 2009.

Conclusions: The most favorable change in the treatment of hypercholesterolemia is an increase in the proportion of patients treated with strong statins. Unfavorable changes include a reduction in the frequency of polytherapy, especially with ezetimibe, and a tendency to prescribe lower, ineffective statin doses.

Article available in PDF format

View PDF Download PDF file

References

  1. Perk J, De Backer G, Gohlke H, et al. European Association for Cardiovascular Prevention & Rehabilitation (EACPR), ESC Committee for Practice Guidelines (CPG). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012; 33(13): 1635–1701.
  2. Yusuf S, Hawken S, Ounpuu S, et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364(9438): 937–952.
  3. Zdrojewski Ł, Zdrojewski T, Rutkowski M, et al. Prevalence and control of cardiovascular risk factors in Poland. Assumptions and objectives of the NATPOL 2011 Survey. Kardiol Pol. 2013; 71(4): 381–392.
  4. Baigent C, Blackwell L, Emberson J, et al. Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010; 376(9753): 1670–1681.
  5. Graham I, Atar D, Borch-Johnsen K, et al. European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG).. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). Eur Heart J. 2007; 28(19): 2375–2414.
  6. Reiner Ž, Catapano AL, De Backer G, et al. European Association for Cardiovascular Prevention & Rehabilitation, ESC Committee for Practice Guidelines (CPG) 2008-2010 and 2010-2012 Committees. 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). Eur Heart J. 2011; 32(14): 1769–1818.
  7. Catapano AL, Graham I, De Backer G, et al. Authors/Task Force Members:, Authors/Task Force Members, Additional Contributor. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016; 37(39): 2999–3058.
  8. Piepoli MF, Hoes AW, Agewall S, et al. Authors/Task Force Members, Additional Contributor, Document Reviewers. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016; 37(29): 2315–2381.
  9. Michalak M, Kołtowski Ł, Jaworski Ł, et al. Is treatment of hypercholesterolemia optimal? Results of the survey assessing ambulatory treatment of hypercholesterolemia in Poland. Pol Przegl Kardiol. 2010; 12: 207–211.
  10. Kołtowski Ł, Michalak M, Jaworski Ł, et al. Do we know how to use ezetimibe in the everyday ambulatory practice? Polish cardiologists survey. Pol Przegl Kardiol. 2010; 12: 269–274.
  11. Kapłon-Cieślicka A, Filipiak KJ. Treatment of hypercholesterolemia in ambulatory care in Poland. Chor Ser Nacz. 2015; 12: 240–248.
  12. Kastelein JJP, Akdim F, Stroes ESG, et al. ENHANCE Investigators. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med. 2008; 358(14): 1431–1443.
  13. Cannon CP, Blazing MA, Giugliano RP, et al. IMPROVE-IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015; 372(25): 2387–2397.
  14. Ginsberg HN, Elam MB, Lovato LC, et al. ACCORD Study Group. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010; 362(17): 1563–1574.
  15. Keech A, Simes RJ, Barter P, et al. FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005; 366(9500): 1849–1861.
  16. Food and Drug Administration. FDA Drug Safety Communication: new restrictions, contraindications, and dose limitations for Zocor (simvastatin) to reduce the risk of muscle injury. http://www.fda.gov/Drugs/DrugSafety/ucm256581.htm (12.12.2015).
  17. Food and Drug Administration. FDA Drug Safety Communication: Important safety label changes to cholesterol-lowering statin drugs. http://www.fda.gov/Drugs/DrugSafety/ucm293101.htm (12.12.2015).
  18. Sukhija R, Prayaga S, Marashdeh M, et al. Effect of statins on fasting plasma glucose in diabetic and nondiabetic patients. J Investig Med. 2009; 57(3): 495–499.
  19. Erqou S, Lee CC, Adler AI, et al. Statins and glycaemic control in individuals with diabetes: a systematic review and meta-analysis. Diabetologia. 2014; 57(12): 2444–2452.
  20. Aiman U, Najmi A, Khan RA. Statin induced diabetes and its clinical implications. J Pharmacol Pharmacother. 2014; 5(3): 181–185.
  21. Cederberg H, Stančáková A, Yaluri N, et al. Increased risk of diabetes with statin treatment is associated with impaired insulin sensitivity and insulin secretion: a 6 year follow-up study of the METSIM cohort. Diabetologia. 2015; 58(5): 1109–1117.
  22. Sliż D, Filipiak KJ, Naruszewicz M, et al. Standards of statin usage in Poland in high-risk patients: 3ST-POL study results. Kardiol Pol. 2013; 71(3): 253–259.
  23. Kotseva K, Wood D, De Backer G, et al. EUROASPIRE Study Group. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009; 16(2): 121–137.
  24. Kotseva K, Wood D, De Bacquer D, et al. EUROASPIRE Investigators. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol. 2016; 23(6): 636–648.