Outcome of Statin Treatment in High Risk Patients at Ban Nasan Hospital
Keywords:
Cardiovascular disease, Diabetes mellitus type II, Ischemic stroke, LDL-Cholesterol, Simvastatin, Atorvastatin, PitavastatinAbstract
Objective : To determine the success rate of decreasing low-density Lipoprotein cholesterol (LDL-C) less than 100 mg/dl. and under target control at least 80 percent in high risk patients.
Material and method : This is a retrospective study of 1,920 patients with type 2 diabetes mellitus (T2DM), ischemic stroke and coronary heart disease (CHD) who were defined as high risk of
cardiovascular disease and had received treatment of hypercholesterolemia with simvastatin or atorvastatin or pitavastatin for at least six months at the Non-Comunicable Disease (NCD) clinic, Ban Nasan Hospital, Surat Thani province between October, 2014 and September,2015. Serum LDL-C level were analyzed and assessed the success rate of achieving LDL-C less than 100 mg/dl. as divide into groups of statin using and group of diseases.Result : The results demonstrated that the success rate of lipid lowering by using statins in all high risk patients was 71.25%. Also, the control of target LDL-C by using simvastatin 20 mg, simvastatin 40 mg,atorvastatin 20 mg and pitavastatin 2 mg were at 68.94%, 74.70%,76.47%, and 70.98%, respectively. In addition, the control of target LDL-C level according to the group of diseases mainly was DM was 71.98% with a mean LDL-C of 89.26 mg/dl; ischemic stroke was 57.14% with a mean LDL-C of 90.56 mg/dl; CHD was 63.64% with a mean LDLC of 87.14 mg/dl; DM with ischemic stroke was 69.75% (83/119) with a mean LDL-C of 89.32 mg/dl; and DM with CHD was 59.62% with a mean LDL-C of 92.32 mg/dl.Conclusion : The success rate of lipid lowering by using statins
in all high risk patients at Ban Nasan Hospital was 71.25%. Improvement in achieving LDL-C goal other than control of blood pressure and glucose is required in clinical practice to reduce the risk of cardiovascular events
References
patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) .Lancet 1995 ;344:1383–9.
2. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, Macfarlane PW, et al for the West of Scotland Coronary Prevention study Group. Prevention of Coronary Heart Disease with Pravastatin in Men with hypercholesterolemia.N Engl J Med 1995;333: 1301-7.
3. MRC/BHF . Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high - risk individuals:
a randomized placebo - controlled trial .Lancet 2002 ;360 : 7 – 22 .
4. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischemic heart disease, and stroke : systematic review and meta-analysis . BMJ. 2003; 326: 1423.
5. Executive Summary of The Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 2001;285:2486.
6. Grundy SM , Cleeman JI, BaireyMerz CN, Clark LT, Hunninghake DB, Pasternack RC, et al. Implications
of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines . Circulation 2004 ;110 :227–39.
7. Baigent C, Blackwell L, Emberson J, Holland LE,Reith C, Bhala N, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a metaanalysis of data from 170,000 participants in 26 randomised trials. Lancet ;2010:376-1670.
8. Law MR , Wald NJ , Rudnicka AR . Quantifying effect of statins on low density lipoprotein cholesterol,
ischaemic heart disease, and stroke: systematic review and meta - analysis .BMJ 2003 ;326:1423–7.
9. Andrew T, Daniel G, Raymond T, Mary T, Jennifer L, Shahin J, et al. Contemporary Management of
Dyslipidemia in High-Risk Patients: Targets Still Not Met. AMJ med 2006;119: 676–683.
10. Hyo-Soo K, Yangfeng W, Shing-Jong L, Chaicharn D, Robaayah Z, Liancheng Z, et al. Current status
of cholesterol goal attainment after statin therapy among patients with hypercholesterolemia in Asian
countries and region: the Return on Expenditure Achieved for Lipid Therapy in Asia (REALITY-Asia) study. CMRO 2008;24: 1951-1963.
11. Sukonthasarn A, Homsanit M, Prommete B, Chotinaiwattarakul C, Piamsomboon C, Likittanasombat
K, Lipid-lowering treatment in hypercholesterolemic patients: the CEPHEUS Thailand survey. J Med Assoc Thai 2011; 94(12):1424-1434.
12. Physicians ’ Desk Reference . Montvale, NJ :Medical Economics, 2007.
13. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/ AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adult: a report of American College of Cardiolgy / American Heart Association Task Force on Practice Guideline. Circulation 2014;129:S1.
14. Stein E, Result of phase I/II clinical trials with ezetimibe, a novel selective cholesterol absorption inhibitor. European Heart Journal Supplements 2001;3:E11.
