Abstract 14759: Statin Switching: Trends in LDL-C and Predictors of ATP-III Goal Attainment
Background: Statins constitute the mainstay of pharmacological therapy for reduction of LDL-C and are an integral component of risk reduction in pts with cardiovascular (CV) disease. In clinical practice statin switching occurs frequently for various indications; however data on achieved LDL-C post-switch is lacking. To address this issue we conducted a retrospective cohort analysis to assess the effect of statin switching on LDL-C levels and to identify predictors of poor LDL-C goal attainment.
Methods: The study population consisted of 1411 pts (61% male, age 64±12 yrs) in whom 1587 statin switching episodes occurred from Jan 2003 to Aug 2010. Complete demographic data, CV risk profiles, insurance, and lab data within 3 months pre- and post-switch were assessed. High-risk CV pts were identified as per NCEP guidelines. Statins were classified by potency and whether branded vs. generic at enrollment.
Results: (see table). For the entire cohort baseline LDL-C was 101±42 mg/dL and 93±36 mg/dL after switching (p <0.001); LDL-C increased in 41% (mean 21±1 mg/dL). Among high CV risk pts (n=1019, 65% of the cohort), 42% experienced increased LDL-C averaging 20±1 mg/dL; 25% of this high-risk group failed to reach LDL-C <100 mg/dL. Among pts switched from branded to generic drugs (n=1028), 44% had an increased LDL-C (mean 20±1 mg/dL). Multivariate analysis identified female gender, commercial insurance, and baseline high potency statin as predictors of poor post-switch LDL-C goal attainment.
Conclusions: In this cohort of pts undergoing statin switching, population LDL-C decreased but more than 40% had increased LDL-C post-switch. Similar trends were observed in other subgroups. Predictors of poor LDL-C goal attainment were female gender, commercial insurance, and high potency drug prior to switching. Loss of LDL-C control may place pts at increased risk for future adverse CV events. Further study to determine the effects of statin switching on clinical outcomes is warranted.
- © 2013 by American Heart Association, Inc.