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Effectiveness of lipid-lowering therapy among a sample of patients in Colombia. Eficacia del tratamiento acuerso en una muestra de pacientes de Colombia.
Send correspondence to Jorge Enrique Machado-Alba, email: To determine the effectiveness of lipid-lowering therapy in a sample of patients affiliated with the Sistema General de Seguridad Social en Salud the Colombian health system. From a total of 8 patients in 10 cities, a random sample of was stratified according to dyslipidemia.
Information on sociodemographic and anthropometric characteristics, risk factors, and pharmacological and laboratory variables were obtained from medical records. Subjects were predominantly female The patients were being treated with lovastatin In patients with high cardiovascular risk, Among those at moderate risk, On average, there was a 4.
Because a lack LDL-C control occurred in patients with two or more of the following variables: Dyslipidemias; anticholesteremic agents, efficacy; cardiovascular diseases; lovastatin; gemfibrozil; Colombia. Determinar la eficacia del tratamiento hipolipemiante en una muestra de pacientes afiliados al Sistema General de Seguridad Social en Salud de Colombia.
Dislipidemias; anticolesterolemiantes; enfermedades cardiovasculares; lovastatina; gemfibrozilo; Colombia. When life expectancy and income increase among a population, so does the prevalence of noncommunicable diseases NCDssuch as hypertension, obesity, dyslipidemia, and diabetes. Worldwide, heart disease and stroke represent the two most common causes of death, with dyslipidemia being a primary risk factor 1, 2.
In Colombia, the mortality rate due to cardiovascular disease CVD ranks first among women, and second among men. Under these circumstances, strategies aimed at identifying individuals with dyslipidemia and implementing primary and secondary CVD preventive measures have become health priorities. To provide physicians with tools for dyslipidemia detection, assessment, and treatment, several panels of experts have developed clinical guidelines 7, 8.
The goal of the ATP III is for the Framingham score to quantify each patient’s “absolute risk of coronary heart disease over 10 years” during routine medical consultation 7, 9.
When these recommendations have been rigorously implemented, the results are fewer cardiovascular events, improved quality of life, and lower dyslipidemia sequelae-related costs Colombia has adopted an essential drugs list into the Plan Obligatorio de Salud Mandatory Health Plan, POS ; initially it included three generic agents for dyslipidemia management: Inatorvastatin was added to the list To access other dyslipidemia control medications, the prescribing physician makes a special acuetdo through each Empresa Promotora de Salud health services provider, EPS to the Scientific Technical Committee CTC 11, Patients also have the legal right to request access to a drug not on the list.
The present study evaluated the effectiveness of lipid-lowering therapies in dislipidemic patients affiliated with the SGSSS. Several associated factors were also examined: Study design and sample. This was a cross-sectional retrospective study of patients who were: These cities were selected for convenience because they had relevant and reliable acuerdoo available.
Statistical software was used to select subjects in a stratified random sampling, by city, from among the 8 patients receiving lipid-lowering drugs out of a total of 3. The quality of the patient records was reviewed by two physicians. Any incomplete record was replaced by the complete record of another randomized patient from the same city and of the same sex and age group.
Patient information was reviewed systematically by a physician using a designated data collection form to obtain the following study 0029 from the medical records: Therapy adherence was determined by the degree to which the patient complied with the recommendations recorded by the doctor in the medical record. The effectiveness of lipid-lowering therapies was established based on the following groups, defined according to the ATP III goal set and whether it was achieved or not: The chi-square test was used to establish associations between variables based on the risk subgroup.
Mean differences were determined by a nonparametric test i. Models of binary logistic regression were applied using the LDL-C and triglyceride levels as the dependent variable, and variables that were acufrdo with the dependent variable were considered covariables in the bivariate analysis. The 09 of the population analyzed are shown in Table 1.
The use of lipid-lowering drugs was examined, and the number of patients receiving monotherapy was acuero follows: The mean doses that were used were: The main comorbidities and co-medications used to manage these and other risk factors are shown in Table 1.
In cases Measurements of LDL-C at treatment initiation were found for patients LDL-C measurements taken in the 6 zcuerdo prior to the study were available for cases Additionally, differences between the initial mean: In the patients comprising risk group 1, Of the 25 patients in risk group 3, Notably, the therapy acuedro changed in Controlled versus uncontrolled dyslipidemic patients.
For risk group 1, the average dose of lovastatin was higher in the controlled patients than in the uncontrolled 74 vs.
In risk group 2, the average dose of lovastatin was lower in the controlled patients than in the uncontrolled 62 vs. None of the other three groups showed statistically-significant differences between doses of lovastatin.
In risk group 5, the average dose of gemfibrozil was greater in the controlled patients aduerdo in the uncontrolled 2 vs. Table 2 shows the results of the bivariate analysis that compared the subgroup of patients whose total-C was controlled versus the uncontrolled subgroup.
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A significant association was found between the rate of total-C control and the following variables: Table 3 presents the results of the bivariate analysis that compared a subgroup of patients with controlled dyslipidemia with a subgroup of patients with uncontrolled dyslipidemia belonging to risk group 1. A statistically significant association was found between the rate of dyslipidemia control and the following variables: There was no statistical significance with the following variables: Table 4 shows the results of the bivariate analysis comparing the subgroup of patients with controlled dyslipidemia to the uncontrolled subgroup, belonging to risk group 2.
A statistically-significant association was found between the rate of dyslipidemia control and the following variables: Given that multiple studies have documented that hypercholesterolemia increases the risk of developing CVD, its control has become a goal of physicians 1. The present study, which showed that This is worrisome because the study sample was from a patient population with easy access to medication. Also of note is that the entire sample of patients received generic drugs.
Additionally, the rate of triglyceride control was The frequency of use of different lipid-lowering drugs, e. In this study the controlled patients received doses of lovastatin that were significantly higher than those administered to the uncontrolled patients, but all patients received DDDs lower than the recommended values, as has been reported elsewhere Most patients in the present study had other risk factors that increased the difficulty of dyslipidemia management and control, especially for asymptomatic diseases, such as hypertension, diabetes, and hypothyroidism; and the use of additional medications for each of these problems results in patients with polypharmacy, as reported by another study It was found that the prevalence of aspirin use as a prophylaxis of cardiovascular risk was higher than that reported by other studies It is disconcerting that only In cases where the target LDL-C level was not being met, and if all patients are considered to have complied with the adjustments, then therapy modifications were insufficient 19, It has been shown that quality-of-care improvement programs for patients with metabolic disorders can achieve great changes and reduce complications through effective therapy Unfortunately, dyslipidemia treatment meets the three conditions that are associated with poor adherence: In this study, however, the proportion of patients who claim to have followed the correct treatment was relatively high, which is in contrast to the low rate of metabolic control This can be correlated with a lack of knowledge on the part of many physicians around what is a desirable goal based on the patient’s risk and what drug and dose should be prescribed to reach it Furthermore, the importance of the starting dose to the overall effectiveness of the therapy has been underscored by a study showing that the percentage reduction in LDL-C levels achieved with the initial dose of statins was strongly correlated with the proportion of patients who maintained their goals at 54 weeks; therefore, it is recommended that therapy start at a dose that should achieve the goal, and if insufficient, be increased significantly to achieve it Clinicians should proactively identify patients at high risk of heart disease and treat them aggressively according to the desired lipid level target, first with statins, and then by adding other drugs if necessary There is also evidence that earlier interventions produce more cost-effective results It has even been suggested that a suboptimal statin treatment may increase the risk of coronary events However, despite the guidelines and the evidence of treatment benefits and safety, numerous studies have shown that a small proportion of dyslipidemic patients regularly use lipid-lowering drugs, and an even smaller percentage of people treated have serum cholesterol levels within the range recommended by international protocols A difference was found between the initial and final LDL-C levels despite the statistically-significant reduction percentages, which are lower than those reported for lovastatin by other studies 4.
However, with high doses of this drug, the values are quite close to the results of one study 6. The reasons for this discrepancy may include using a lower dose than recommended, problems with treatment adherence, and a lack of medical management goals 19, 24, According to the results of the present study, the prevalent characteristics of patients in the high cardiovascular risk group with uncontrolled dyslipidemia are two or more of following variables: The above findings support increasing the dose of the lipid-lowering therapy based on clearly defined objectives 16, Additionally, the presence of comorbidities, such as diabetes mellitus, which contribute to cardiovascular risk, should be evaluated for treatment with the drug of choice and at the appropriate dose The physician must make decisions and modify patient management when achieving the therapeutic goal is difficult 19, Conversely, it is recommended that insurance companies monitor treatment effectiveness, and even adjust the medication in question, or recommend that the clinician do so This research was funded by Audifarma S.
One of the authors has a contractual relationship with both funding organizations, but this did not affect the content of the manuscript.
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Effectiveness and tolerability of ezetimibe co-administered with statins versus statin dose-doubling in high-risk patients with persistent hyperlipidemia: Cardiovascular disease and lipids.
Issues and evidence for the management of dyslipidaemia in primary care. Eur J Gen Pract. Rev Crs Publica Bogota. Reduction of global cardiovascular risk with nutritional versus nutritional plus physical activity intervention in Colombian adults.