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Titration patterns with rosuvastatin as compared with other statins in clinical practice: a retrospective observational cohort study using an electronic medical record database.
Clin Ther. 2007 Nov; 29(11):2385-94.CT

Abstract

BACKGROUND

Lipid management in clinical practice has been suboptimal with a significant proportion of patients not achieving recommended cholesterol levels. A reason for low goal attainment may be the limited use of upward dose titration.

OBJECTIVE

The aim of this study was to determine if, in routine clinical practice, a lower rate of titration is observed among rosuvastatin patients who achieved the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) target low-density lipoprotein cholesterol (LDL-C) goals as compared with patients achieving the target LDL-C goals on other statins.

METHODS

This retrospective database study included the patients, aged > or =18 years, of approximately 3000 physicians across the United States, who were newly prescribed statin treatment from August 2003 to May 2005. Patients were excluded if they started on a maximum dose of statin, were at LDL-C goal at baseline (no clinical reason for titrating), or on fluvastatin (<70 patients). Titration rate with rosuvastatin was compared with other statins. Multivariate logistic regression models adjusted for baseline LDL-C, coronary heart disease risk, treatment duration, and target LDL-C goal attainment.

RESULTS

This study assessed 12,041 patients for upward titration. Of the 5955 eligible patients (mean age, 63 years; male, 47%), 7.2% were prescribed rosuvastatin, 63.5% atorvastatin, 15.3% simvastatin, 7.2% pravastatin, and 6.9% lovastatin. Overall, 4337 patients (72.8%) attained the NCEP ATP III target LDL-C goal. Mean duration of statin treatment was 188 days for rosuvastatin compared with 238 to 260 days for the other statins (all, P < 0.05). Among patients attaining the target LDL-C goal, significantly fewer rosuvastatin patients (8.3%) had titration compared with atorvastatin (17.0%), simvastatin (20.0%), pravastatin (20.7%), and lovastatin (23.5%) (all, P < 0.05). After adjusting for baseline characteristics, patients attaining the target LDL-C goal on other statins were significantly more likely to be titrated as compared with rosuvastatin (odds ratios, 2.0-3.3; P < 0.05). Lower titration rates for rosuvastatin patients were also observed in the total population (P < 0.05).

CONCLUSION

Our study found that rosuvastatin patients who attained the NCEP ATP III target LDL-C goal had significantly lower titration rates than patients receiving other statins.

Authors+Show Affiliations

Department of Epidemiology & Preventive Medicine, School of Medicine, University of Maryland, Baltimore, MD, USA. kathyfox@comcast.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18158079

Citation

Fox, Kathleen M., et al. "Titration Patterns With Rosuvastatin as Compared With Other Statins in Clinical Practice: a Retrospective Observational Cohort Study Using an Electronic Medical Record Database." Clinical Therapeutics, vol. 29, no. 11, 2007, pp. 2385-94.
Fox KM, Gandhi SK, Ohsfeldt RL, et al. Titration patterns with rosuvastatin as compared with other statins in clinical practice: a retrospective observational cohort study using an electronic medical record database. Clin Ther. 2007;29(11):2385-94.
Fox, K. M., Gandhi, S. K., Ohsfeldt, R. L., Blasetto, J. W., & Davidson, M. H. (2007). Titration patterns with rosuvastatin as compared with other statins in clinical practice: a retrospective observational cohort study using an electronic medical record database. Clinical Therapeutics, 29(11), 2385-94.
Fox KM, et al. Titration Patterns With Rosuvastatin as Compared With Other Statins in Clinical Practice: a Retrospective Observational Cohort Study Using an Electronic Medical Record Database. Clin Ther. 2007;29(11):2385-94. PubMed PMID: 18158079.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Titration patterns with rosuvastatin as compared with other statins in clinical practice: a retrospective observational cohort study using an electronic medical record database. AU - Fox,Kathleen M, AU - Gandhi,Sanjay K, AU - Ohsfeldt,Robert L, AU - Blasetto,James W, AU - Davidson,Michael H, PY - 2007/07/25/accepted PY - 2007/12/26/pubmed PY - 2008/2/21/medline PY - 2007/12/26/entrez SP - 2385 EP - 94 JF - Clinical therapeutics JO - Clin Ther VL - 29 IS - 11 N2 - BACKGROUND: Lipid management in clinical practice has been suboptimal with a significant proportion of patients not achieving recommended cholesterol levels. A reason for low goal attainment may be the limited use of upward dose titration. OBJECTIVE: The aim of this study was to determine if, in routine clinical practice, a lower rate of titration is observed among rosuvastatin patients who achieved the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) target low-density lipoprotein cholesterol (LDL-C) goals as compared with patients achieving the target LDL-C goals on other statins. METHODS: This retrospective database study included the patients, aged > or =18 years, of approximately 3000 physicians across the United States, who were newly prescribed statin treatment from August 2003 to May 2005. Patients were excluded if they started on a maximum dose of statin, were at LDL-C goal at baseline (no clinical reason for titrating), or on fluvastatin (<70 patients). Titration rate with rosuvastatin was compared with other statins. Multivariate logistic regression models adjusted for baseline LDL-C, coronary heart disease risk, treatment duration, and target LDL-C goal attainment. RESULTS: This study assessed 12,041 patients for upward titration. Of the 5955 eligible patients (mean age, 63 years; male, 47%), 7.2% were prescribed rosuvastatin, 63.5% atorvastatin, 15.3% simvastatin, 7.2% pravastatin, and 6.9% lovastatin. Overall, 4337 patients (72.8%) attained the NCEP ATP III target LDL-C goal. Mean duration of statin treatment was 188 days for rosuvastatin compared with 238 to 260 days for the other statins (all, P < 0.05). Among patients attaining the target LDL-C goal, significantly fewer rosuvastatin patients (8.3%) had titration compared with atorvastatin (17.0%), simvastatin (20.0%), pravastatin (20.7%), and lovastatin (23.5%) (all, P < 0.05). After adjusting for baseline characteristics, patients attaining the target LDL-C goal on other statins were significantly more likely to be titrated as compared with rosuvastatin (odds ratios, 2.0-3.3; P < 0.05). Lower titration rates for rosuvastatin patients were also observed in the total population (P < 0.05). CONCLUSION: Our study found that rosuvastatin patients who attained the NCEP ATP III target LDL-C goal had significantly lower titration rates than patients receiving other statins. SN - 0149-2918 UR - https://www.unboundmedicine.com/medline/citation/18158079/Titration_patterns_with_rosuvastatin_as_compared_with_other_statins_in_clinical_practice:_a_retrospective_observational_cohort_study_using_an_electronic_medical_record_database_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(07)00359-1 DB - PRIME DP - Unbound Medicine ER -