Abstract
Background: HMG-CoA reductase inhibitors (statins) are efficacious for treatment and prevention of cardiovascular disease (CVD). Adherence is problematic due to side effects which prevent high risk patients from receiving benefit from statins. Aim: The aim of this study was to evaluate the effectiveness of a nurse practitioner (NP) alternate statin dosing protocol for the reduction of total cholesterol (TC) and low-density lipoprotein (LDL-C). Methods: 15 women who had the inability to tolerate daily dosing were analyzed using a novel NP protocol for initiation and maintenance of alternate dosing utilizing atorvastatin, pravastatin, or rosuvastatin. Patients were started on twice weekly statin dosing for 4 weeks then titrated up one dose per week as tolerated. While on alternate statin dosing, fasting lipid levels were ordered and obtained by chart review. We compared baseline and alternate day dosing by Wilcoxon signed rank test. Results: We evaluated 15 female patients with a mean age of 62 ± 14 years and BMI 26 ± 5 kg/m2. Overall, 60% had CVD, 60% had hypertension, 7% had diabetes, and 47% had a history of smoking but currently non-smokers. Prior to the study, all women were intolerant to 2 or more statins. Utilizing the alternate dosing NP protocol, we observed a 32% reduction in LDL-C, to a mean of 84 ± 39 mg/dl compared to the baseline mean of 134 ± 49 mg/dl (p
Highlights
Cardiovascular disease (CVD) is the single largest killer of women, [1] and more women than men die each year despite advancements in life-saving therapies [2]
Among women with statin intolerance, an nurse practitioner (NP) statin alternate dosing protocol is effective in reducing total cholesterol (TC) and LDL-C levels
Patients with a total blood cholesterol level greater than 200 mg/dL have a two-fold risk of developing CVD [3]. 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors are currently the most effective treatment for lowering total cholesterol (TC), calculated low density lipoprotein (LDL-C), and CVD risk [4]
Summary
Cardiovascular disease (CVD) is the single largest killer of women, [1] and more women than men die each year despite advancements in life-saving therapies [2]. Patients with a total blood cholesterol level greater than 200 mg/dL have a two-fold risk of developing CVD [3]. 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) are currently the most effective treatment for lowering total cholesterol (TC), calculated low density lipoprotein (LDL-C), and CVD risk [4]. Despite diagnosis and treatment in women, CVD death reduction has not matched that of men [5]. Women have less compliance to statin medication than men [6]. Poor adherence to statins may be related to medication costs and side effects. We tested a nurse practitioner (NP) guided protocol which is aimed at reducing TC and LDL-C in women with prior statin intolerance due to myalgias
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