Negative Trials May Influence Trends in Lipid-Lowering Therapies

The use of non-statin lipid-lowering therapies have declined among older patients with coronary heart disease (CHD), a trend which coincides with negative trial results for these medications, according to research published Oct. 19 in the Journal of the American College of Cardiology.

Researchers, led by Vera Bittner, MD, MSPH, FACC, studied 310,091 Medicare beneficiaries with CHD and divided them into 20 cohorts of individuals representing quarters between 2007 and 2011. Results showed the use of statins increased over the study period, from 53.1 percent in 2007 to 58.8 percent (14.2 percent high intensity) in 2011. Further, ezetimibe use peaked at 12.1 percent in 2007 and declined to 4.6 percent at the end of 2011. Fibrate use increased from 4.2 percent to 5.0 percent, niacin use increased from 1.5 percent to 2.4 percent, and then declined slightly in late 2011 and bile acid sequestrants did not significantly change.

The researchers note that they saw a reduction in the use of non-statin lipid-lowering therapies, “primarily due to a marked reduction in the use of ezetimibe,” even though national cholesterol guidelines and treatment targets remained unchanged during this period. However, they believe that the discontinuation of ezetimibe use was due to concerns specific to the medication rather than guidance based on patient characteristics.

In an accompanying editorial comment, Peter P. Toth, MD, PhD, FACC, concludes that “there is much yet to be learned about residual risk and the role of adjuvant lipid-lowering therapy. However, as this study makes clear, the prescribing of lipid-lowering medication by health care providers and its responsiveness to clinical trials is an issue that warrants much careful additional study. In the meantime, it is crucial that statins and adjuvant therapies with demonstrable efficacy be used appropriately in order to help more patients achieve guideline-determined goals for LDL-C reduction, especially among the elderly.”

Clinical Topics: Dyslipidemia, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Cholesterol, Coronary Artery Disease, Coronary Disease, Fibric Acids, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medicare, Niacin

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