title: Lipid-lowering treatment patterns in patients with new cardiovascular events - estimates from population-based register data in Sweden.
abstract: OBJECTIVE
  The aim of this study was to assess treatment patterns of lipid-lowering therapy (LLT) in patients with hyperlipidaemia or prior cardiovascular (CV) events who experience new CV events.
  
  
  METHODS
  A retrospective population-based cohort study was conducted using Swedish medical records and registers. Patients were included in the study based on a prescription of LLT or CV event history and followed up for up to 7 years for identification of new CV events and assessment of LLT treatment patterns. Patients were stratified into three cohorts based on CV risk level. All outcomes were assessed during the year following index (the date of first new CV event). Adherence was defined as medication possession ratio (MPR) > 0.80. Persistence was defined as no gaps > 60 days in supply of drug used at index.
  
  
  RESULTS
  Of patients with major cardiovascular disease (CVD) history (n = 6881), 49% were not on LLT at index. Corresponding data for CV risk equivalent and low/unknown CV risk patients were 37% (n = 3226) and 38% (n = 2497) respectively. MPR for patients on LLT at index was similar across cohorts (0.74-0.75). The proportions of adherent (60-63%) and persistent patients (56-57%) were also similar across cohorts. Dose escalation from dose at index was seen within all cohorts and 2-3% of patients switched to a different LLT after index while 5-6% of patients augmented treatment by adding another LLT.
  
  
  CONCLUSIONS
  Almost 50% of patients with major CVD history were not on any LLT, indicating a potential therapeutic gap. Medication adherence and persistence among patients on LLT were suboptimal.
authors.affiliation: Quantify Research, Stockholm, Sweden.
authors.forename: S
authors.identifier: http://orcid.org/0000-0003-2164-8060
authors.initials: S
authors.lastname: Hallberg
authors.affiliation: Quantify Research, Stockholm, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Banefelt
authors.affiliation: Strategic Healthcare Solutions, LLC, Baltimore, MD, USA.
authors.forename: K M
authors.identifier: http://orcid.org/0000-0003-2100-277X
authors.initials: KM
authors.lastname: Fox
authors.affiliation: Quantify Research, Stockholm, Sweden.|LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Mesterton
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Johansson
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: L-Å
authors.initials: LÅ
authors.lastname: Levin
authors.affiliation: LIME/Medical Management Centre, Karolinska Institute, Stockholm, Sweden.|IMS Health, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Sobocki
authors.affiliation: Amgen Inc., Thousand Oaks, CA, United States.
authors.forename: S R
authors.initials: SR
authors.lastname: Gandra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069059:Atorvastatin / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000517:prevention & control; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017035:Pravastatin / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D019821:Simvastatin / Q000627:therapeutic use; D013548:Sweden
chemical_list: D000924:Anticholesteremic Agents; D000069059:Atorvastatin; D019821:Simvastatin; D017035:Pravastatin