Retrospective evaluation of statin therapy medication-taking behaviors and achievement of low density lipoprotein goals by coronary heart disease risk
Fee, Kelly Ann
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National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) has identified low density lipoprotein cholesterol (LDL-C) as the largest modifiable risk factor leading to CHD. A variety of drug and non-drug treatments are available for hyperlipidemia, and HMG CoA Reductase Inhibitors or "statins" are the most potent and most widely used agents to lower LDL-C. The purpose of this investigation was to evaluate the medication-taking behaviors of patients taking statins as well as the achievement of their LDL-C goals. These outcomes were examined using both the 2001 NCEP ATP III guidelines and the 2004 Updated Optional NCEP ATP III guidelines. Patients were grouped by CHD severity as promulgated by each of these guidelines. In this retrospective investigation, statin-naïve patients were identified and selected from the Scott & White Health Plan, a health maintenance organization in central Texas, between October 1, 2004 and June 1, 2005. Their prescription records and medical records were examined for a year after the first stain fill. A total of 550 patients met inclusion criteria; 272 were not at NCEP ATP III LDL-C goal at baseline and 407 were not at Updated Optional NCEP ATP III LDL-C goal at baseline. Approximately one-third of patients were adherent at least 80% of the time over the one-year follow-up period. Patients were persistent on therapy with no more than a 15-day gap after the exhaustion of each refill for a mean of 155 days. There was no statistical difference between risk groups when examining medication-taking behavior. In the one-year follow-up period, more than half of patients met NCEP ATP III LDL-C goals and approximately 44% of patients met Updated Optional NCEP ATP III LDL-C goals. Those at high risk met NCEP ATP III LDL-C goals the least frequently (p = 0.0368). Those at very high risk and moderately high risk met Updated Optional NCEP ATP III LDL-C goals the least frequently (p < 0.0001). In this sample, patient adherence and persistence were low. The number of patients reaching LDL-C goals was also low. Fewer patients met the newer Updated Optional NCEP ATP III LDL-C goals. Treating and preventing CHD reduces mortality in the American adult population. Future research investigating medication-taking behavior and goal attainment is needed to determine how best to treat patients.