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Low-Density Lipoprotein Cholesterol Levels Among Individuals Receiving Statin Therapy: Real-World Evidence from India

Received: 25 January 2021     Accepted: 20 February 2021     Published: 9 March 2021
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Abstract

Despite the established clinical effectiveness of statin therapy, a substantial proportion of patients fail to attain the target low-density lipoprotein cholesterol (LDL-C) levels and remain at risk for cardiovascular events. This study aimed to evaluate the proportion of patients achieving the guideline recommended LDL-C levels in real-world settings after receiving statins for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. The study included a cross-sectional retrospective analysis of medical records from 2281 private healthcare facilities between 2017 and 2018. Overall, 15879 patients aged 20-80 years irrespective of their ASCVD status were included. Mean (±SD) age of patients was 55.96±10.41 years; 62.8% were men, and 44.6% (n=7076) had clinical ASCVD. Overall, 96.2% (n=15271) patients were receiving statins, 99.3% in the secondary prevention and 93.6% in the primary prevention cohort. Most patients were receiving moderate-intensity statins for primary (89.7%, n=7391) and secondary ASCVD prevention (73.4%, n=5159). None of the patients in the secondary prevention cohort achieved the recommended LDL-C level of <70 mg/dL. Approximately 25.3% (n=2089) individuals in the primary prevention and 20.2% (n=1418) in the secondary prevention cohort achieved LDL-C <100 mg/dL. Similar proportion (23.2%, n=3361) of patients with LDL-C control (<100 mg/dL) were found among the high-risk coronary heart disease (CHD) or CHD-equivalent group (including those with diabetes). This large real-world study demonstrated levels of LDL-C that were higher than guideline recommended targets, especially among ASCVD patients, despite receiving statin therapy. The results highlight major gaps in the real-world practice of prescribing statin therapy for both primary and secondary prevention of ASCVD. Concordance to guideline recommended therapy, timely dose titration, use of alternative drugs, and patient adherence can bridge this gap and help achieve optimal control of LDL-C. Further intensification of therapy with addition of non-statins is recommended if LDL-C goals are not achieved among high-risk population.

Published in American Journal of Health Research (Volume 9, Issue 1)
DOI 10.11648/j.ajhr.20210901.13
Page(s) 16-25
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Low-density Lipoprotein Cholesterol (LDL-C), Cardiovascular Diseases, Statin Therapy, Real-World Evidence, India

References
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  • APA Style

    Surendra Shamkant Borgharkar, Soma Soumitra Das. (2021). Low-Density Lipoprotein Cholesterol Levels Among Individuals Receiving Statin Therapy: Real-World Evidence from India. American Journal of Health Research, 9(1), 16-25. https://doi.org/10.11648/j.ajhr.20210901.13

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    Surendra Shamkant Borgharkar; Soma Soumitra Das. Low-Density Lipoprotein Cholesterol Levels Among Individuals Receiving Statin Therapy: Real-World Evidence from India. Am. J. Health Res. 2021, 9(1), 16-25. doi: 10.11648/j.ajhr.20210901.13

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    AMA Style

    Surendra Shamkant Borgharkar, Soma Soumitra Das. Low-Density Lipoprotein Cholesterol Levels Among Individuals Receiving Statin Therapy: Real-World Evidence from India. Am J Health Res. 2021;9(1):16-25. doi: 10.11648/j.ajhr.20210901.13

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  • @article{10.11648/j.ajhr.20210901.13,
      author = {Surendra Shamkant Borgharkar and Soma Soumitra Das},
      title = {Low-Density Lipoprotein Cholesterol Levels Among Individuals Receiving Statin Therapy: Real-World Evidence from India},
      journal = {American Journal of Health Research},
      volume = {9},
      number = {1},
      pages = {16-25},
      doi = {10.11648/j.ajhr.20210901.13},
      url = {https://doi.org/10.11648/j.ajhr.20210901.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20210901.13},
      abstract = {Despite the established clinical effectiveness of statin therapy, a substantial proportion of patients fail to attain the target low-density lipoprotein cholesterol (LDL-C) levels and remain at risk for cardiovascular events. This study aimed to evaluate the proportion of patients achieving the guideline recommended LDL-C levels in real-world settings after receiving statins for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. The study included a cross-sectional retrospective analysis of medical records from 2281 private healthcare facilities between 2017 and 2018. Overall, 15879 patients aged 20-80 years irrespective of their ASCVD status were included. Mean (±SD) age of patients was 55.96±10.41 years; 62.8% were men, and 44.6% (n=7076) had clinical ASCVD. Overall, 96.2% (n=15271) patients were receiving statins, 99.3% in the secondary prevention and 93.6% in the primary prevention cohort. Most patients were receiving moderate-intensity statins for primary (89.7%, n=7391) and secondary ASCVD prevention (73.4%, n=5159). None of the patients in the secondary prevention cohort achieved the recommended LDL-C level of <70 mg/dL. Approximately 25.3% (n=2089) individuals in the primary prevention and 20.2% (n=1418) in the secondary prevention cohort achieved LDL-C <100 mg/dL. Similar proportion (23.2%, n=3361) of patients with LDL-C control (<100 mg/dL) were found among the high-risk coronary heart disease (CHD) or CHD-equivalent group (including those with diabetes). This large real-world study demonstrated levels of LDL-C that were higher than guideline recommended targets, especially among ASCVD patients, despite receiving statin therapy. The results highlight major gaps in the real-world practice of prescribing statin therapy for both primary and secondary prevention of ASCVD. Concordance to guideline recommended therapy, timely dose titration, use of alternative drugs, and patient adherence can bridge this gap and help achieve optimal control of LDL-C. Further intensification of therapy with addition of non-statins is recommended if LDL-C goals are not achieved among high-risk population.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Low-Density Lipoprotein Cholesterol Levels Among Individuals Receiving Statin Therapy: Real-World Evidence from India
    AU  - Surendra Shamkant Borgharkar
    AU  - Soma Soumitra Das
    Y1  - 2021/03/09
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajhr.20210901.13
    DO  - 10.11648/j.ajhr.20210901.13
    T2  - American Journal of Health Research
    JF  - American Journal of Health Research
    JO  - American Journal of Health Research
    SP  - 16
    EP  - 25
    PB  - Science Publishing Group
    SN  - 2330-8796
    UR  - https://doi.org/10.11648/j.ajhr.20210901.13
    AB  - Despite the established clinical effectiveness of statin therapy, a substantial proportion of patients fail to attain the target low-density lipoprotein cholesterol (LDL-C) levels and remain at risk for cardiovascular events. This study aimed to evaluate the proportion of patients achieving the guideline recommended LDL-C levels in real-world settings after receiving statins for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. The study included a cross-sectional retrospective analysis of medical records from 2281 private healthcare facilities between 2017 and 2018. Overall, 15879 patients aged 20-80 years irrespective of their ASCVD status were included. Mean (±SD) age of patients was 55.96±10.41 years; 62.8% were men, and 44.6% (n=7076) had clinical ASCVD. Overall, 96.2% (n=15271) patients were receiving statins, 99.3% in the secondary prevention and 93.6% in the primary prevention cohort. Most patients were receiving moderate-intensity statins for primary (89.7%, n=7391) and secondary ASCVD prevention (73.4%, n=5159). None of the patients in the secondary prevention cohort achieved the recommended LDL-C level of <70 mg/dL. Approximately 25.3% (n=2089) individuals in the primary prevention and 20.2% (n=1418) in the secondary prevention cohort achieved LDL-C <100 mg/dL. Similar proportion (23.2%, n=3361) of patients with LDL-C control (<100 mg/dL) were found among the high-risk coronary heart disease (CHD) or CHD-equivalent group (including those with diabetes). This large real-world study demonstrated levels of LDL-C that were higher than guideline recommended targets, especially among ASCVD patients, despite receiving statin therapy. The results highlight major gaps in the real-world practice of prescribing statin therapy for both primary and secondary prevention of ASCVD. Concordance to guideline recommended therapy, timely dose titration, use of alternative drugs, and patient adherence can bridge this gap and help achieve optimal control of LDL-C. Further intensification of therapy with addition of non-statins is recommended if LDL-C goals are not achieved among high-risk population.
    VL  - 9
    IS  - 1
    ER  - 

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