Lipid-lowering treatment in hypercholesterolemic patients: the CEPHEUS Thailand survey.
ABSTRACT Atherosclerotic cardiovascular disease (ASCVD) has become the leading cause of death and disability in Thailand. Low-density lipoprotein cholesterol is the major risk factor of this condition that can be intervened by means of lifestyle modification and pharmacologic treatment. Adequacy of hypercholesterolemia treatment with lipid lowering drugs in Thailand needed to be more clarified. The present study was conducted to determine low-density cholesterol goal attainment in Thai population at risk for developing ASCVD.
Twenty-seven physicians with their 909 hypercholesterolemic patients whose age of > or = 18 years, actively under pharmacologic treatment for at least three months with no dose adjustment for a minimum of six weeks from seven centers across Thailand were enrolled. Plasma glucose, total cholesterol, LDL cholesterol, HDL-cholesterol, and triglyceride levels were measured after overnight fast. Demographic and other relevant data including information on lipid lowering drug used were retrieved. Patients' awareness, knowledge on their management, compliance, and satisfaction were evaluated by questionnaire survey as well as physicians' use of guidelines, choice of management and goal setting, and their attitudes towards lipid management. Cardiovascular risk level and LDL goal were assessed by the updated 2004 NCEP-ATP III guidelines.
All patients had LDL goal of < 130 mg/dl with 86.1% needed LDL goal of < 100 mg/dL. Overall, 52.7% of the patients reached their LDL goal. The most prescribed treatment was statin monotherapy (82.7%). LDL goal attainment was inversely associated with LDL goal set by NCEP-ATP III according to the patients' risk profile, with only 16.7% of those who were in the very high risk group with LDL goal of < 70 mg/dL achieved their goal whereas 60.6% and 84.7% of those with high (LDL goal < 100 mg/dl) and moderately high-risk (LDL goal < 130 mg/dl) achieved their goal, respectively (p < 0.001). Other factors associated with less favorable LDL goal attainment were coronary heart disease, carotid artery disease, diabetes, 10-year risk of > 20%, and metabolic syndrome (p < 0.05 for all). Type of lipid lowering drug was not significantly associated with LDL goal attainment.
LDL goal attainment was not achieved in a high proportion of Thai patients especially in those who had high to very high risk for developing cardiovascular disease. Despite availability of well-established treatment guideline and efficacious lipid lowering drugs, many patients still miss the opportunity to effectively control their lipid profile.
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ABSTRACT: BACKGROUND: HMG-CoA reductase inhibitors [statins], a widely prescribed cholesterol-lowering therapy, are associated with muscle-related adverse events. While characteristics of such events are well documented in Western countries, little data exists for the Thai population. OBJECTIVE: The aim of this study was to determine the characteristics of patients, type and dosing of statin, and to identify patterns of drug use that may be associated with such adverse events using the national pharmacovigilance database known as Thai Vigibase. METHOD: Muscle-related adverse events involving statins in the Thai Vigibase from 1996 to December 2009 were identified. For each report, the following information was extracted: patient demographics, co-morbidities, detailed information of adverse event, detailed information of suspected drug, treatment and outcome, as well as causality assessment and quality of reports. Descriptive statistics were performed for all study variables. RESULTS: A total of 198 cases of statin-associated muscle-related adverse events were identified. Mean age was 61.4 ± 12.4 years of age and 59.6 % were female. Simvastatin, atorvastatin, rosuvastatin and cerivastatin were implicated as the suspected drug in 163 (82.3 %), 24 (12.1 %), 10 (5.1 %) and 1 (0.5 %) cases, respectively. Rhabdomyolysis accounted for 55.6 % of all muscle-related adverse events. Drug interactions known to enhance such toxicity of statins were identified in 40.9 % of the total set of reports. Similar to studies from Western countries, fibrates, HIV protease inhibitors, non-dihydropyridine calcium channel blockers, azole antifungals and macrolides were commonly found in such cases. Interestingly, colchicine has been identified as the second most common drug interaction in our database. Case fatality rates were 0.9, 1.6 and 16.7 %, when there were 0, 1 and ≥2 interacting drugs, respectively. CONCLUSIONS: Characteristics of muscle-related adverse events with statins in the Thai population showed some similarities and differences compared with Western countries. Such similarities included advanced age, female sex, certain co-morbidities and drug interactions. While the majority of interacting drugs are well known, a big proportion of cases of statin-colchicine interaction attributed to long-term use of colchicine in Thailand was noted and should be further investigated. Based on these results, an attempt to avoid dangerous and well-known drug interactions among statin users should be implemented nationwide.Drug Safety 04/2013; · 3.41 Impact Factor