title: Patterns of statin use and cholesterol goal attainment in a high-risk cardiovascular population: A retrospective study of primary care electronic medical records.
abstract: OBJECTIVE
  To describe real-life patterns of statin use and cholesterol goal attainment in a retrospective cohort of patients with high cardiovascular risk.
  
  
  METHODS
  Retrospective cohort study of 21,636 individuals, 18.34% women, mean age 63.30 years (standard deviation 6.29). New statin users aged 35 to 74 years at high cardiovascular risk and with no previous cardiovascular disease in primary care electronic medical records (2006-2011). Patterns of statin use were based on statin type, potency, and 1-year statin switches.
  
  
  RESULTS
  Relative mean reductions over 1 year and probability of goal attainment (<3.3 mmol/L). Natural patterns of statin use were identified using multiple correspondence analysis; general linear and logistic models were used to estimate low-density lipoprotein cholesterol (LDL-C) reductions and goal attainment probability.
  
  
  RESULTS
  Three patterns of statin use were defined: low (3.82% of the population), moderate (71.94%), and high intensity (24.24%). After 1 year, potency decreased 42.74%, 64.16%, and 50.94%, respectively, and 37.41%, 29.47%, and 30.16% of the population stopped taking statins in low, moderate, and high patterns, respectively. Relative reductions in LDL-C: low intensity, 15.7% (95% confidence interval [CI]: -22.96 to 54.36); moderate intensity, 29.72% (95% CI: 29.12-30.32); and high intensity, 24.20% (95% CI: -8.08 to 40.32). There was a direct relationship between higher intensity patterns and greater probability of goal attainment.
  
  
  CONCLUSIONS
  Three real-life patterns of statin use were identified. Lipid management strategies in primary care should focus on improving adherence to treatment. People starting at low potency should switch to a moderate pattern; more intensive therapies should be considered in who require a larger LDL-C reduction to reach therapeutic targets, patients with good treatment adherence who do not achieve the goal with a moderate pattern of therapy or patients at very high risk.
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Spain; Catalan Institute of Health (ICS), Catalunya, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Spain. Electronic address: mgarcia@idiapjgol.info.
authors.forename: Maria
authors.initials: M
authors.lastname: García-Gil
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Spain; Catalan Institute of Health (ICS), Catalunya, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Blanch
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Spain; Catalan Institute of Health (ICS), Catalunya, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Comas-Cufí
authors.affiliation: Department of Computer Sciences, Applied Mathematics and Statistics, University of Girona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Daunis-i-Estadella
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain.
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Bolíbar
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Spain; Catalan Institute of Health (ICS), Catalunya, Spain; Biomedical Research Institute, Girona (IdIBGi), Catalunya, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: Martí
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Spain; Catalan Institute of Health (ICS), Catalunya, Spain; Biomedical Research Institute, Girona (IdIBGi), Catalunya, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Ponjoan
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Spain; Catalan Institute of Health (ICS), Catalunya, Spain.
authors.forename: Lia
authors.initials: L
authors.lastname: Alves-Cabratosa
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Spain; Catalan Institute of Health (ICS), Catalunya, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Spain; Biomedical Research Institute, Girona (IdIBGi), Catalunya, Spain.
authors.forename: Rafel
authors.initials: R
authors.lastname: Ramos
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood* / Q000188:drug therapy*; D008078:Cholesterol, LDL / Q000097:blood; D057286:Electronic Health Records; D005260:Female; D006040:Goals; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Cardiovascular risk; Electronic medical records; LDL cholesterol; Primary care; Statins