Statin Medication In Patients Research Articles

Population health model for pharmacist assessment and independent prescribing of statins in an ambulatory care setting

ObjectiveThis study aimed to evaluate the impact of a pharmacist population health initiative on the ability to increase the percentage of patients with atherosclerotic cardiovascular disease (ASCVD) who are on an appropriate statin. SettingTen primary care clinics in Southwest Washington. The average payer mix across the included clinics is 47% Medicare, 26% commercial, 22% Medicaid, 2% self-pay, and 3% other. Reimbursement-tied statin quality metrics are present in 14.1% of patients’ insurance contracts. Practice descriptionThe primary care pharmacy collaborative drug therapy agreement allows pharmacists to act as prescribers by permitting initiation, adjustment, and monitoring of medication therapy, with the authority historically stemming from referral by the patient’s primary care provider to the pharmacist. Practice innovationA novel, population health protocolized prescriptive authority (PPA) initiative was implemented, of which a key component was expanding pharmacists’ prescriptive authority to prescribe statins for population health initiatives. Without referral, pharmacists screened, directly outreached to, and prescribed statins for patients with ASCVD who were not on a moderate- or high-intensity statin. Electronic health record (EHR) documentation was updated to better reflect the patient’s history and increase metric accuracy. EvaluationA retrospective analysis of a population health initiative from October 1 to December 31, 2018. The initiative was evaluated on the combined success of initiating patients with ASCVD on moderate- or high-intensity statins and the acceptance rate of EHR corrections. ResultsThe pharmacy team screened 510 patients. Appropriately dosed statins were initiated for 40.0% of patients, and the EHR was accurately updated in 91.9% of instances. These combined efforts demonstrate 50.5% overall success of pharmacist interventions. ConclusionExpanding pharmacists’ authority to PPA for statin medications in patients not meeting quality metrics increased the number of successful interventions. Pharmacists make a major contribution on improving population health metrics for statins.

Statin use among Veterans with dialysis-dependent chronic kidney disease.

The benefits of statin medications in patients receiving maintenance dialysis remains controversial and clinical trials overall have shown no benefit. Potential side effects of statin medications include myalgias, myopathy, and memory loss and risk of side effects associated with statin medications increase with higher statin doses. We examined statin use and statin dose among Veterans with dialysis dependent CKD. Such information may help clinicians modulate medication use and reduce pill burden in appropriate patients. This cross-sectional analysis ascertained medication utilization by linking records from the U.S. Department of Veteran's Affairs (VA) Managerial Cost Accounting Pharmacy National Data Extracts and Medicare Part D during calendar year 2013 for Veterans with dialysis-dependent CKD enrolled in and/or using VA healthcare. The venue of dialysis and patient characteristics were ascertained by linking VA Medical SAS datasets, VA Fee Basis datasets (for non-VA care paid for by VA), Medicare claims and the United States Renal Data Systems patient core files. We identified 18,494 Veterans with dialysis-dependent CKD who were enrolled in and/or used VA healthcare, had no history of kidney transplantation, and were alive on January 1, 2014. More than half (58.1%) of Veterans with dialysis-dependent CKD used statins and 35.7% of statin utilization was high dose. Statins were the third most commonly prescribed medication after beta blockers (64.8%) and phosphate binders (64.5%). Statins are a commonly prescribed medication among Veterans receiving maintenance dialysis and approximately one-third of statin utilization is high dose in this population. Future studies should examine patient preferences, comorbidities, and dialysis characteristics that impact the risks and benefits of statin use in order to identify those patients who will or will not benefit from continued statin use.

Neighborhood socioeconomic characteristics and statin medication in patients with myocardial infarction: a Swedish nationwide follow-up study

BackgroundCoronary heart disease (CHD) and myocardial infarction (MI) are associated with neighborhood-level socioeconomic status (SES). Statins are important drugs for secondary prevention of MI. However, no study has determined whether neighborhood-level SES is associated with statin medication in MI patients. We aimed to determine whether there is a difference in statin medication rate in MI patients across different levels of neighborhood SES.MethodsAll patients in Sweden, diagnosed with incident MI from January 1st, 2000 until December 31st 2010, were followed (n = 116,840). Of these, 89.7 % received statin medication. Data were analyzed by multilevel logistic regression, with individual-level characteristics (age, marital status, family income, educational attainment, country of origin, urban/rural status and comorbidities/chronic conditions related to MI) as covariates.ResultsLow neighborhood-level SES was significantly associated with low statin medication rate (Odds Ratio 0.80). In the full model, which took into account individual-level socioeconomic characteristics and MI comorbidities, the odds no longer remained significant.ConclusionsIndividual-level approaches may be most important in health care policies regarding statin medication in MI patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0319-y) contains supplementary material, which is available to authorized users.

Statin medication in patients with epiretinal membrane is associated with low intravitreal EPO, TGF-beta-1, and VEGF levels.

BackgroundIn eyes with idiopathic epiretinal membrane (iERM), the intravitreal growth factor and cytokine levels may associate with postvitrectomy outcomes. Here, we have analyzed the perioperative intravitreal protein levels of potent vasoactive, proinflammatory, and extracellular matrix-remodeling factors in iERM eyes and evaluated the postvitrectomy outcomes.MethodsThis was an institutional, observational study. Eyes operated on for iERM (n=26) were analyzed according to the use of statin medication. Vitreous samples were subjected to protein measurements of angiopoietin-1 and -2, erythropoietin, transforming growth factor-β1, and vascular endothelial growth factor by enzyme-linked immunosorbent assay, and of matrix metalloproteinase-2 and -9 by gelatin zymography. One-month visual outcomes and 1-year revitrectomy rates were recorded.ResultsIn iERM eyes of patients taking statins, intravitreal levels of erythropoietin (mean ± standard deviation, 10.8±4.9 vs 82.9±119.5 mIU/mg, P=0.003), transforming growth factor-β1 (2.3±4.7 vs 15.8±16.3 pg/mg, P=0.035), and vascular endothelial growth factor (5.5±9.9 vs 236.6±491.6 pg/mg, P=0.006) were lower than in nonstatin-treated patients. At 1-month, visual gain did not significantly differ between iERM eyes of patients with statins and those without (improvement 0.27±0.20 vs 0.16±0.38 logarithm of the minimum angle of resolution units, P=0.118).ConclusionSystemic statin therapy might have a favorable effect on intravitreal factors involved in vascular permeability, inflammation, and fibroproliferation in aging human iERM eyes.

Shared decision making between Chinese medical staff members and patients with coronary heart disease: study protocol for a multicenter, large sample, cross-sectional, open-label, clinical survey

Background: Shared decision making is an emerging approach through which physicians and patients can reach health care decisions based on mutual agreement. Scientific physician-patient shared decision making can facilitate selection of optimized treatments, improvement in curative effects, postoperative prognosis, and short-term and long-term rehabilitation in patients with coronary heart disease. However, there have been no studies on Chinese physicians' and patients' attitude to shared decision making. Methods/Design: This is a multicenter, large sample, cross-sectional, open-label, clinical survey. Participants are 1,000 Chinese patients with coronary heart disease and 200 medical staff members of both sexes over 18 years old. The primary survey index is the satisfaction of medical staff members and coronary heart disease patients with shared decision making. The secondary survey indices include staff and patient satisfaction with a clinical decision-making aid, patients' awareness of disease risk and curative benefits, and physician-patient trust. Discussion: This study is the first to investigate the attitude of Chinese medical staff members and coronary heart disease patients to clinical shared decision making and to examine the feasibility of using this approach. This study provides an evidence-based foundation for investigating the problems and solutions of clinical shared decision making and strengthening the adherence to statin medication in patients with coronary heart disease. Trial registration: This study protocol was registered at Chinese Clinical Trial Registry (registration number: ChiCTR-OCS-14004646). Ethics: This study protocol has been approved by Ethics Committee, The First Affiliated Hospital of Dalian Medical University (approval number: LCKY2014-14) and will be performed in strict accordance with the Declaration of Helsinki, formulated by the World Medical Association. Informed consent: Signed informed consent will be obtained from each included subject.

Statin use in cancer patients with brain metastases: a missed communication opportunity at the end of life.

Preventive care, referring to medical interventions with anticipated long-term benefits, is often inappropriately continued near the end of life. We examined the use of statin medications in patients with brain metastases receiving whole brain radiation therapy to determine the effect of short life expectancy and regular interaction with oncology providers on statin discontinuation. We propose reasons for the unnecessary continuation of preventive care and suggest that it is a frequently missed communication opportunity to discuss prognosis in a concrete manner. This is a retrospective study examining statin use in patients receiving whole brain radiotherapy for brain metastases. A total of 206 patients at two cancer centers were studied, and information on statin use and clinical characteristics was obtained from review of the medical record. Of the 206 patients, 53 (26 %) were on a statin at their initial radiation oncology consultation. Of these patients, 13 (25 %) had their statin discontinued by the time of their last follow-up visit, but 40 patients (75 %) were continued on their statin despite their limited life expectancy and low likelihood of benefit. The majority of patients who were on statins prior to starting palliative whole brain radiation therapy remained on a statin after completing treatment despite an estimated survival of months and regular visits with an oncologist. This represents a missed opportunity for doctors and patients to discuss the appropriateness of continuing preventive care as part of an important conversation about prognosis.

Statins and Risk of New-Onset Diabetes Mellitus

For any prescription drug, the potential benefits to health must be balanced against potential risks. Understanding these potential risks can help physicians and patients make informed decisions on whether to use a medication. Recently, statins, a class of medications prescribed to treat high cholesterol levels, have been found to modestly increase the risk of developing diabetes mellitus. It is clear that statins can prevent future major cardiovascular events, such as heart attack, stroke, and deaths from cardiovascular causes, in patients who have had a previous heart attack or those with multiple cardiovascular risk factors. However, the associations between diabetes mellitus and statin use have raised concerns over the widespread use of statin medications in patients at lower risk for cardiovascular disease. In this Patient Page, we describe the indications for statin therapy, the most common adverse effects, and recent concerns about new-onset diabetes mellitus to help patients and providers make more informed decisions about the use of this important class of medications in at-risk individuals. Cardiovascular disease is a major cause of illness and death worldwide. Elevated blood cholesterol levels (specifically the low-density lipoprotein [LDL] cholesterol) are associated with a higher risk of heart attack, stroke, and heart failure. It has become clear that elevated LDL cholesterol levels predict future events, and modern risk scores such as the Framingham Risk Score use LDL cholesterol level as an important predictor of future cardiac events.1 In addition, as new large trials shed light on the important role of LDL in cardiac disease, the optimal LDL cholesterol level has been progressively lowered in national guidelines. Statins are a class of medications called 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. These drugs block a critical …

Statin medication in patients treated with antiepileptic drugs in Norway

The lipid-lowering response of statins metabolized by cytochrome P450 3A4 (CYP3A4) has previously been shown to be diminished by concurrent use of enzyme-inducing antiepileptic drugs (EIAEDs). The aim of this study was to compare statin prescription in patients receiving EIAEDs versus non-enzyme-inducing antiepileptic drugs (NEIAEDs), before and after introduction of prescribing restrictions for statins in Norway. The Norwegian Prescription Database was used to extract data on patients using antiepileptic drugs and statins during 2004 and 2008. Statin type and dose used were compared between patients treated with at least one EIAED (i.e., carbamazepine, phenobarbital, phenytoin, primidone) and those receiving NEIAEDs only (i.e., all other antiepileptic drugs). The number of included patients co-medicated with statins and AEDs was 4855 in 2004 and 9880 in 2008. Among these patients, 2827 and 3160, respectively, were treated with EIAEDs. The CYP3A4 statins (i.e., simvastatin, atorvastatin and lovastatin) accounted for 85% of all statins in 2004, increasing to 93% in 2008. There was no significant difference in the likelihood of being prescribed a CYP3A4 statin versus a non-CYP3A4 statin among patients receiving EIAEDs and NEIAEDs. The average daily dose of individual CYP3A4 statins was not different between the AED groups. The present study shows that the interaction risk between CYP3A4-metabolized statins and EIAEDs is largely overlooked in Norwegian clinical practice. To avoid therapeutic failure of statin treatment in patients using AEDs, implementation of strategies for systematic management of drug interactions is warranted.

Statins, low cholesterol, and hemorrhagic stroke

Does low serum cholesterol trigger intracerebral hemorrhage? Such a link was first suggested by early epidemiologic studies, though this apparent relationship has appeared weaker in more recent prospective studies.1 But even if convincingly demonstrated by observational studies, does low cholesterol truly cause hemorrhagic stroke, or is it merely a marker or epiphenomenon of a hemorrhage-prone individual? Trials of cholesterol-lowering agents could potentially settle the causality question, but have also not yielded a clear-cut verdict. Recent studies of statin medications in patients with coronary artery disease have failed to reveal an increased risk of hemorrhagic stroke.2 One could argue, however, that since these studies were performed in patients with coronary heart disease, their interpretation may be limited. They were mainly conducted with middle-aged persons, while the population most at risk for stroke is older. Persons in these studies may also have been more likely to succumb to coronary disease and less likely to develop stroke at an older …

Are statin medications safe in patients with ALS?

Statin medications for elevated cholesterol are one of the most commonly prescribed medications worldwide. The aim of this study was to determine if statin medications affect the rate of disease progression, the severity and frequency of muscle cramping, and serum CK levels in patients with ALS. We conducted a prospective cohort study in patients diagnosed with ALS with statin medication as the predetermined exposure variable and the rate of decline of the ALS Functional Rating Scale-Revised (ALSFRS-R) as the primary outcome. One hundred and sixty-four consecutive patients with laboratory supported probable, clinically probable, or clinically definite ALS were evaluated from January 2006 to September 2007. Thirty-two patients (20%) were taking statin medications and 132 were in the control group. After adjusting for covariates, we found a highly significant increase in the rate of decline in the ALSFRS-R for the statin group (1.71 units/month) compared to the control group (1.05 units/month, pB0.0001) representing a 63% increase in the rate of functional decline. Patients on statin therapy also reported a significant increase in muscle cramp frequency and severity (pB0.0001). This study has demonstrated a strong association between statin medications and an increased rate of functional decline and muscle cramping in patients with ALS. Although this association does not prove a causal relationship, it is prudent to exercise caution and discuss discontinuation or replacement of statin medications in patients with ALS.

Effect of fluvastatin on low-density lipoprotein peak particle diameter

In this investigation, there was no appreciable effect on LDL particle diameter and there was no greater or lesser effect in patients classified at baseline as LDL pattern A, B, or I. This investigation indicates that fluvastatin, a 3-Hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitor, can significantly reduce LDL cholesterol, but has no effect on LDL particle diameter and no differential effect on patients characterized by differences in LDL subclass pattern. This contributes additional information on the lack of a differential effect of this statin medication in patients classified at baseline as LDL pattern A, B, or I.