Lipid-lowering therapy in patients with coronary artery disease in primary care practices: what has changed over 7 years?

Abstract

Aim. To analyze changes in the pattern of lipid-lowering therapy (LLT) in outpatients with stable coronary artery disease (SCAD) over the 7-year period.Material and methods. This pharmacoepidemiological, retrospective, cross-sectional, two-stage study was conducted on the basis of primary care facility of Moscow. We analyzed 1,834 and 805 medical records of patients with SCAD at the first (2011) and second (2018) stages, respectively. Data on demography, medical history, lipid profile, and administrated LLT were collected. Statistical analysis was performed using SPSS Statistics V16.0 and MS Excel. Differences were considered significant at p<0,05.Results. Overall LLT prescription rate in outpatients with SCAD increased from 48,5 up to 86,4% (p<0,05) over the 7-year period. Statin monotherapy continued to prevail in the structure of LLT: its prescription rate increased from 48,2 up to 82,3% (p<0,05) in total sample. Use of statin/ezetimibe combination was registered only in 2018 (2,4% in LLT structure). Atorvastatin was the most frequently recommended medication at both study stages (51,5 vs 66,3%; p<0,05); prescription rate of simvastatin decreased from 44,5 to 3,9% (p<0,05), rosuvastatin — increased from 1,7 to 29,5% (p<0,05). Over the study period, the proportion of patients receiving high-intensity LLT increased (2,0 vs 41,8%; p<0,05). We also revealed a significant increase of patients who reached target levels of low-density lipoprotein cholesterol (11,1 vs 23,3%; p<0,05) and total cholesterol (17,0 vs 33,0%; p<0,05).Conclusion. The results demonstrated significant improvements in the LLT pattern over the 7-year period in outpatients with SCAD. Number of patients receiving statins doubled, and the cases of prescribing lowintensity LLT have become very rare. However, control of blood lipids in the target group remained inadequate.