Managed Care Database Analysis of Statin Therapy Changes

Chicago—An observational cohort study of a managed care database found that after 12 months of treatment, nearly half of high-risk patients discontinued using statins to lower lowdensity lipoprotein cholesterol (LDL-C), leading the authors to conclude that there should be an emphasis on increasing medication adherence among this group. Results were presented during a poster session at the ACC meeting. The poster was titled Treatment Pattern Changes in High-Risk Patients on Statin Monotherapy in a Managed Care Setting. Between January 1, 2006, and August 31, 2009, the authors identified patients ≥18 years of age from the HealthCore Integrated Research Database, which includes claims information from the largest commercially insured population in the United States. Before initiating statin monotherapy, eligible patients were required to have had ≥1 medical claim for coronary heart disease, atherosclerotic vascular disease, or diabetes. To be included in the study, patients also had to have failed to meet the goal of LDL-C level of <70 mg/dL ≥4 weeks after beginning statin monotherapy. All patients had 30-day prescriptions for their statins, and they were considered to have discontinued therapy if they did not fill their prescription within 45 days of their previous fill. At baseline, the mean age of patients was 55.3 years, and 51.3% were male. The most common comorbidity was hypertension, which occurred in 46.9% of patients. Most patients were prescribed simvastatin (44.7%) or atorvastatin (31.5%), while 9.6% were prescribed lovastatin, 8.5% were prescribed pravastatin, 5.1% were prescribed rosuvastatin, and 0.6% were prescribed fluvastatin. Before initiating statin therapy, the mean LDL-C level was 138, which decreased 24% to a mean of 101 when the first lab results were recorded. The authors took the first results ≥4 weeks after the patients began their statin monotherapy. Of the total cohort, 46.9% stopped taking the statins. After the first treatment, 64.9% of patients changed their therapy regimen, with 67.1% increasing the potency because of a statin switch or titration, 26.3% decreasing or keeping the same potency, and 6.6% increasing the potency because they added another therapy to their regimen. The mean time-to-change was 93.8 days. In addition, 13.6% of the patients who had changed their therapy after the first treatment had another treatment change within 12 months. The mean time-to-change was 178.3 days. The authors noted that they also examined the following subgroups: patients with diabetes, patients with coronary heart disease or atherosclerotic vascular disease, and patients with diabetes and atherosclerotic vascular disease. They did not include the results, but they had similar findings when comparing the individual groups with the entire cohort. Although there were some statistically significant between-group differences, the authors said that the differences were not clinically meaningful. The authors concluded that “these treatment patterns demonstrated the need for more patient and provider education as well as other system-wide improvements to increase medication adherence.”