scholarly journals Adherence to and Persistence With Statin Therapy in a Veteran Population

2018 ◽  
Vol 53 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Kendra Morotti ◽  
Julio Lopez ◽  
Vanessa Vaupel ◽  
Arthur Swislocki ◽  
David Siegel
Keyword(s):  
Diabetes Mellitus ◽  
Statin Therapy ◽  
Medication Possession Ratio ◽  
Cardiovascular Risk Reduction ◽  
Factors Affecting ◽  
Patient Demographics ◽  
Elevated Cholesterol ◽  
Initiation Of Therapy ◽  
Statin Adherence

Background: A relative cardiovascular risk reduction of 25% to 35% has been reported in patients starting a statin for elevated cholesterol; yet many patients fail to consistently take these medications as directed. Objective: To evaluate factors affecting adherence and persistence with statin therapy. Methods: This retrospective study analyzed data from a Veterans Affairs database of facilities west of the Rocky Mountains. Patient demographics, co-morbidities, and prescription information was collected for individuals newly prescribed a statin between July 1, 2007, and December 31, 2012. Adherence was determined using the medication possession ratio (MPR). Persistence was defined as the time from initiation of therapy until a refill gap of 135 days or greater occurred. Results: Of 164 687 unique patients, overall adherence to statins a mean MPR of 0.843. Approximately 63% of patients were persistent with statin therapy 675 days after statin initiation. Patients prescribed pravastatin, atorvastatin, lovastatin, and rosuvastatin and those who took more than 1 different statin during the follow-up period had statistically significantly higher rates of adherence than those prescribed simvastatin. Older patients and those with a greater number of active prescriptions were found to be more adherent to statin medications. Patients with hypertension were more adherent to a statin, and those with diabetes mellitus and/or posttraumatic stress disorder (PTSD) were less adherent. Conclusion and Relevance: In veterans, overall statin adherence was excellent. Certain populations may benefit from interventions targeted at improving statin adherence, including younger veterans, those prescribed fewer medications, those taking simvastatin, and veterans with PTSD or diabetes mellitus.

Statin Therapy and Risk of Diabetes Mellitus in Aging Patients With Heterozygous Familial Hypercholesterolemia or Familial Combined Hyperlipidemia: A 10-Year Follow-Up

Angiology ◽  
2017 ◽  
Vol 69 (3) ◽  
pp. 242-248 ◽  
Author(s):  
Ioannis Skoumas ◽  
Nikolaos Ioakeimidis ◽  
Charalambos Vlachopoulos ◽  
Christina Chrysohoou ◽  
Christos Michalakeas ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Statin Therapy ◽  
Familial Hypercholesterolemia ◽  
Familial Combined Hyperlipidemia ◽  
Heterozygous Familial Hypercholesterolemia

Adherence to statin therapy favours survival of patients with symptomatic peripheral artery disease

2019 ◽  
Author(s):  
Jörn F Dopheide ◽  
Jonas Veit ◽  
Hana Ramadani ◽  
Luise Adam ◽  
Lucija Papac ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Peripheral Artery Disease ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Peripheral Artery ◽  
All Cause Mortality ◽  
Statin Medication ◽  
Artery Disease ◽  
Statin Adherence

Abstract Aims  We hypothesized that adherence to statin therapy determines survival in patients with peripheral artery disease (PAD). Methods and results  Single-centre longitudinal observational study with 691 symptomatic PAD patients. Mortality was evaluated over a mean follow-up of 50 ± 26 months. We related statin adherence and low-density lipoprotein cholesterol (LDL-C) target attainment to all-cause mortality. Initially, 73% of our PAD patients were on statins. At follow-up, we observed an increase to 81% (P < 0.0001). Statin dosage, normalized to simvastatin 40 mg, increased from 50 to 58 mg/day (P < 0.0001), and was paralleled by a mean decrease of LDL-C from 97 to 82 mg/dL (P < 0.0001). The proportion of patients receiving a high-intensity statin increased over time from 38% to 62% (P < 0.0001). Patients never receiving statins had a significant higher mortality rate (31%) than patients continuously on statins (13%) or having newly received a statin (8%; P < 0.0001). Moreover, patients on intensified statin medication had a low mortality of 9%. Those who terminated statin medication or reduced statin dosage had a higher mortality (34% and 20%, respectively; P < 0.0001). Multivariate analysis showed that adherence to or an increase of the statin dosage (both P = 0.001), as well as a newly prescribed statin therapy (P = 0.004) independently predicted reduced mortality. Conclusion  Our data suggest that adherence to statin therapy is associated with reduced mortality in symptomatic PAD patients. A strategy of intensive and sustained statin therapy is recommended.

Abstract TP349: Incidence of Cerebral Ischemia Associated Seizures in Patients With Narrowing or Occlusion of the Ipsilateral Internal Carotid or Middle Cerebral Artery: The EC/IC Bypass Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Muhammad Shah Miran ◽  
Ahmed A Malik ◽  
M.Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Diabetes Mellitus ◽  
Relative Risk ◽  
Cerebral Ischemia ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Factors Affecting ◽  
Ischemic Attack ◽  
Patients Experience

Background: Cerebral ischemia associated seizures are well recognized in patients with internal carotid or middle cerebral artery stenosis or occlusion although the incidence is not well documented. Methods: We analyzed the data that was collected on 1377 patients with recent hemisphere strokes, retinal infarction, or transient ischemic attacks with atherosclerotic narrowing or occlusion of the ipsilateral internal carotid or middle cerebral artery who were enrolled in the EC/IC Bypass Study. The patients were followed for an average of 55.8 months and any seizures related to cerebral ischemia based on clinical and imaging criteria were ascertained. We calculated the relative risk in pre-defined patient subgroups: Age (<55 and ≥55 years), gender, presenting symptom (transient ischemic attack and ischemic stroke), allocated treatment (bypass surgery and medical treatment), site of stenosis/occlusion (internal carotid artery and middle cerebral artery), and presence or absence of hypertension and diabetes mellitus. Results: A total of 64 patients experience one or more cerebral ischemia associated seizures during follow up: first seizure was focal and generalized in 33 and 31 patients, respectively. The incidence of cerebral ischemia associated seizures was 1.7 per 100 person observation years. The relative risk of seizures was higher among patients aged <55 years (relative risk 1.36, 95% confidence interval [CI] 0.8-2.2), women (relative risk 1.1, 95% CI 0.6-2.1), with stroke as presenting symptom (RR 1.9, 95% CI 1.1-3.3), with medical group as allocated treatment (RR 1.2,95%CI 0.7-2.0), with middle cerebral artery as site of stenosis/occlusion(RR 1.13, 95% C.I 0.6-2.0), with diabetes mellitus (RR 1.7, 95% CI 0.96-3.0) or hypertension (RR 1.1, 95% CI 0.7-1.8). Conclusions: We provide the incidence of and factors affecting occurrence of cerebral ischemia associated seizures in patients with narrowing or occlusion of the ipsilateral internal carotid or middle cerebral artery

scholarly journals Prednisolone-induced diabetes mellitus in the cat: a historical cohort

2020 ◽  
pp. 1098612X2094352
Author(s):  
Sivert Nerhagen ◽  
Hanne L Moberg ◽  
Gudrun S Boge ◽  
Barbara Glanemann
Keyword(s):  
Diabetes Mellitus ◽  
Electronic Records ◽  
High Dose ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Historical Cohort ◽  
Starting Dose ◽  
Initiation Of Therapy

Objectives Prednisolone is a commonly used drug in cats and potential adverse effects include hyperglycaemia and diabetes mellitus. The aims of this study were to evaluate the frequency and investigate potential predisposing risk factors for the development of prednisolone-induced diabetes mellitus (PIDM) in cats. Methods The electronic records of a tertiary referral centre were searched for cats receiving prednisolone at a starting dose of ⩾1.9 mg/kg/day, for >3 weeks and with follow-up data available for >3 months between January 2007 and July 2019. One hundred and forty-three cats were included in the study. Results Of the 143 cats, 14 cats (9.7%) were diagnosed with PIDM. Twelve out of 14 cats (85.7%) developed diabetes within 3 months of the initiation of therapy. Conclusions and relevance Cats requiring high-dose prednisolone therapy should be closely monitored over the first 3 months of therapy for the development of PIDM.

Predictive Factors of Operative Hemodynamic Instability for Pheochromocytoma

2018 ◽  
Vol 84 (6) ◽  
pp. 920-923 ◽  
Author(s):  
Nihat Aksakal ◽  
Orhan Agcaoglu ◽  
Nuri Alper Sahbaz ◽  
Ozgur Albuz ◽  
Ayten Saracoglu ◽  
...  
Keyword(s):  
Tumor Size ◽  
Operative Time ◽  
Hypertensive Crisis ◽  
Hemodynamic Instability ◽  
Study Patient ◽  
Tumor Diameter ◽  
Factors Affecting ◽  
Patient Demographics ◽  
Catecholamine Levels

Pheochromocytoma is an uncommon catecholamine-secreting tumor in which resection is often associated with hemodynamic instability (HI). In this study, we aim to clarify the factors affecting surgical HI in patients who underwent surgery with the diagnosis of pheochromocytoma. All patients who underwent surgery with the diagnosis of pheochromocytoma between 2008 and 2015 were analyzed retrospectively. Patients with inconsistent diagnosis or missing outcomes and follow-up data were excluded. A total of 37 patients were included in this study. Patient demographics, operative time, tumor size, period of medical treatment until surgery, catecholamine levels in urine, and HI patterns were analyzed. There were 23 (62%) male and 14 (38%) female patients. Hemodynamic instability occurred in 13 (35%) patients. Overall, HI was higher in patients with tumor size <6 cm (P < 0.02); moreover, urine catecholamine levels were detected significantly higher than a cutoff value of 2000 mg/24 hours in hemodynamically instable group. In this study, tumor diameter of <6 cm and urine catecholamine levels >2000 mg/24 hours were associated with HI. Preoperative management is essential for preventing hypertensive crisis and HI before or during surgery.

Factors affecting diabetes mellitus onset in cystic fibrosis: evidence from a 10-year follow-up study

2007 ◽  
Vol 88 (4) ◽  
pp. 389-393 ◽  
Author(s):  
D Cucinotta ◽  
F Luca ◽  
R Scoglio ◽  
F Lombardo ◽  
C Sferlazzas ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cystic Fibrosis ◽  
Factors Affecting ◽  
Follow Up Study

scholarly journals Statin adherence is lower in primary than secondary prevention: A national follow-up study of new users

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242424
Author(s):  
Finn Sigglekow ◽  
Simon Horsburgh ◽  
Lianne Parkin
Keyword(s):  
Primary Prevention ◽  
Secondary Prevention ◽  
Medication Possession Ratio ◽  
Statin Treatment ◽  
Group A ◽  
Hospital Discharge Records ◽  
Statin Medication ◽  
Statin Adherence ◽  
Dispensing Data

Background Maintaining adherence to statins reduces the risk of an initial cardiovascular disease (CVD) event in high-risk individuals (primary prevention) and additional CVD events following the first event (secondary prevention). The effectiveness of statin therapy is limited by the level of adherence maintained by the patient. We undertook a nationwide study to compare adherence and discontinuation in primary and secondary prevention patients. Methods Dispensing data from New Zealand community pharmacies were used to identify patients who received their first statin dispensing between 2006 and 2011. The Medication Possession Ratio (MPR) and proportion who discontinued statin medication was calculated for the year following first statin dispensing for patients with a minimum of two dispensings. Adherence was defined as an MPR ≥ 0.8. Previous CVD was identified using hospital discharge records. Multivariable logistic regression was used to control for demographic and statin characteristics. Results Between 2006 and 2011 289,666 new statin users were identified with 238,855 (82.5%) receiving the statin for primary prevention compared to 50,811 (17.5%) who received it for secondary prevention. The secondary prevention group was 1.55 (95% CI 1.51–1.59) times as likely to be adherent and 0.67 (95% CI 0.65–0.69) times as likely to discontinue statin treatment than the primary prevention group. An early gap in statin coverage increased the odds of discontinuing statin treatment. Conclusion Adherence to statin medication is higher in secondary prevention than primary prevention. Within each group, a range of demographic and treatment factors further influences adherence.

PAD patients present with poorer lipid target attainment than polyvascular patients – a call for intensified treatment

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.F Dopheide ◽  
L Adam ◽  
M Khorrami Borozadi ◽  
M Kaspar ◽  
I Baumgartner ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Lower Mortality ◽  
Lipid Lowering ◽  
Target Attainment ◽  
Statin Medication ◽  
Vascular Beds ◽  
Artery Disease ◽  
Statin Adherence ◽  
Statin Use

Abstract Background Due to the very high risk of future cardiovascular events, strict lipid lowering therapy is recommended in patients with peripheral artery disease (PAD). However, data on target level attainment and statin adherence is scarce, especially when the atherosclerotic burden is extended to other vascular beds, i.e. coronary artery disease (CAD) and/ or cerebrovascular disease (CeVD). Purpose We hypothesized that patients with PAD alone have poorer lipid target attainment than polyvascular patients (+ CAD and/ or CeVD) and that an intensified statin therapy improves attainment of lipid targets and thus survival of patients with PAD only. Methods Single center longitudinal observational study with 1380 symptomatic PAD patients over a mean follow-up period of 60±32 months. We related statin adherence and LDL-C target attainment to all-cause mortality. Results Initially, 58% of the PAD only patients were on statins in contrast to PAD patients with one (+1V (79%)) or two (+2V (80%)) further vascular regions. At follow up we observed an increase to 87% statin use (p&lt;0.0001) in PAD only patients. Statin use in +1V and +2V patients increased as well (+1V: 92%; +2V: 87%). Lipid target attainment in PAD only (&lt;55 mg/dl) was observed in only 10%, but increased to 19%. Statin dosage in PAD only patients, normalized to simvastatin 40 mg, increased from 46 to 52 mg/ day (p&lt;0.01), and was paralleled by a mean decrease of LDL-C from 103 to 84 mg/ dL (p&lt;0.0001). PAD only patients had a significant lower mortality rate (13%) than +1V (22%) or +2V patients (35%) (p&lt;0.0001). Survival of PAD only patients significantly improved when having newly received a statin (11%), similar to those continuously on statins (10%). Moreover, patients on a high intensity statin medication had a low mortality of 10%. Those who terminated statin medication or never received a statin had a higher mortality (26%; p&lt;0.01). Conclusion Patients with a PAD only have a lower mortality than PAD patients where progression to one or two vascular beds occurred. Our data suggest that for PAD only patients an intensified statin therapy is then associated with reduced mortality. A strategy of intensive and sustained statin therapy as early as possible is recommended. PAD only Statin Therapy outcomes Funding Acknowledgement Type of funding source: None

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