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Niacin and fibrate use among patients with high triglycerides and low high-density lipoprotein cholesterol.
Curr Med Res Opin. 2009 Jun; 25(6):1355-63.CM

Abstract

BACKGROUND

National guidelines recommend treating low HDL and/or high triglycerides (TG) with adjunctive therapy that supplements statin monotherapy in patients with multiple cardiovascular disease (CVD) risk factors. Niacin and fibrates have been shown in clinical trials to be effective as adjunctive therapy for these lipid abnormalities.

OBJECTIVE

To evaluate the pharmacologic treatment of low HDL and high TG in real-world practice by assessing a large managed-care population with CVD risk factors enrolled in a commercial health plan.

RESEARCH DESIGN AND METHODS

Complete lipid panel results (LDL, HDL, TG) obtained between 1/1/2006 and 12/31/2006 (index lab) were available for all participants. Subjects were observed 180 days pre-index to determine which CVD risk factors were present (male aged 45+, female 55+, coronary heart disease, hypertension, diabetes mellitus). Patients whose LDL was at goal but who had low HDL and high TG were assessed for lipid treatment status by evaluating outpatient pharmacy claims 6 months pre- and post-index.

RESULTS

Treatment with any lipid therapy increased for all risk groups, and by total risk factors, from pre-index to post-index. Use of fibrates and niacin, alone or in combination with a statin, also increased for all risk groups, and by total risk factors as well, but was below expectations based on guideline recommendations. For example, among patients with 4 risk factors, <20% of patients with low HDL/high TG received niacin and/or a fibrate post-index date.

CONCLUSIONS

Our results indicate that in actual clinical practice, niacin and fibrates are underutilized in the treatment of low HDL and high TG. The findings of this study must be considered within the limitations of database analysis as claims data are collected for the purpose of payment and not research.

Authors+Show Affiliations

Sterling Rock Falls Clinic, Sterling, IL 61081, USA. Peter.toth@srfc.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

19425901

Citation

Toth, Peter P., et al. "Niacin and Fibrate Use Among Patients With High Triglycerides and Low High-density Lipoprotein Cholesterol." Current Medical Research and Opinion, vol. 25, no. 6, 2009, pp. 1355-63.
Toth PP, Zarotsky V, Sullivan JM, et al. Niacin and fibrate use among patients with high triglycerides and low high-density lipoprotein cholesterol. Curr Med Res Opin. 2009;25(6):1355-63.
Toth, P. P., Zarotsky, V., Sullivan, J. M., & Laitinen, D. (2009). Niacin and fibrate use among patients with high triglycerides and low high-density lipoprotein cholesterol. Current Medical Research and Opinion, 25(6), 1355-63. https://doi.org/10.1185/03007990902910450
Toth PP, et al. Niacin and Fibrate Use Among Patients With High Triglycerides and Low High-density Lipoprotein Cholesterol. Curr Med Res Opin. 2009;25(6):1355-63. PubMed PMID: 19425901.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Niacin and fibrate use among patients with high triglycerides and low high-density lipoprotein cholesterol. AU - Toth,Peter P, AU - Zarotsky,Victoria, AU - Sullivan,Jane M, AU - Laitinen,Dave, PY - 2009/5/12/entrez PY - 2009/5/12/pubmed PY - 2010/6/12/medline SP - 1355 EP - 63 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 25 IS - 6 N2 - BACKGROUND: National guidelines recommend treating low HDL and/or high triglycerides (TG) with adjunctive therapy that supplements statin monotherapy in patients with multiple cardiovascular disease (CVD) risk factors. Niacin and fibrates have been shown in clinical trials to be effective as adjunctive therapy for these lipid abnormalities. OBJECTIVE: To evaluate the pharmacologic treatment of low HDL and high TG in real-world practice by assessing a large managed-care population with CVD risk factors enrolled in a commercial health plan. RESEARCH DESIGN AND METHODS: Complete lipid panel results (LDL, HDL, TG) obtained between 1/1/2006 and 12/31/2006 (index lab) were available for all participants. Subjects were observed 180 days pre-index to determine which CVD risk factors were present (male aged 45+, female 55+, coronary heart disease, hypertension, diabetes mellitus). Patients whose LDL was at goal but who had low HDL and high TG were assessed for lipid treatment status by evaluating outpatient pharmacy claims 6 months pre- and post-index. RESULTS: Treatment with any lipid therapy increased for all risk groups, and by total risk factors, from pre-index to post-index. Use of fibrates and niacin, alone or in combination with a statin, also increased for all risk groups, and by total risk factors as well, but was below expectations based on guideline recommendations. For example, among patients with 4 risk factors, <20% of patients with low HDL/high TG received niacin and/or a fibrate post-index date. CONCLUSIONS: Our results indicate that in actual clinical practice, niacin and fibrates are underutilized in the treatment of low HDL and high TG. The findings of this study must be considered within the limitations of database analysis as claims data are collected for the purpose of payment and not research. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/19425901/Niacin_and_fibrate_use_among_patients_with_high_triglycerides_and_low_high_density_lipoprotein_cholesterol_ L2 - http://www.tandfonline.com/doi/full/10.1185/03007990902910450 DB - PRIME DP - Unbound Medicine ER -