title: LDL cholesterol response and statin adherence among high-risk patients initiating treatment.
abstract: OBJECTIVE
  The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol treatment guideline recommends monitoring percent reduction in low-density lipoprotein cholesterol (LDL-C) among patients initiating statins as an indication of response and adherence. We examined LDL-C reduction and statin adherence among high-risk patients initiating statins in a real-world setting.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  The study population included Kaiser Permanente Georgia members (n = 1066) with a history of coronary heart disease or risk equivalent(s) initiating statins in 2011. Percent change in LDL-C was defined using measurements before and 60 to 450 days after statin initiation. Statin adherence was defined by proportion of days covered, categorized as high (≥80%), intermediate (50%-79%), and low (< 50%).
  
  
  RESULTS
  Overall, 58.4% of patients failed to achieve a ≥ 30% LDL-C reduction after statin initiation. The prevalences of high, intermediate, and low statin adherence were 41.3%, 23.2%, and 35.6%, respectively. Of patients with high adherence, 42.3% did not achieve a ≥ 30% reduction in LDL-C compared with 54.7% and 79.7% of those with intermediate and low statin adherence, respectively. After multivariable adjustment, and compared with those with high adherence, the risk ratios for not achieving a ≥ 30% LDL-C reduction were 1.31 (95% CI, 1.13-1.52) and 1.88 (95% CI, 1.67-2.11), for those with intermediate and low adherence. Women and African Americans were less likely to have high adherence, whereas having cardiologist visits was associated with high adherence.
  
  
  CONCLUSIONS
  In a real-world setting, many patients did not achieve a 30% or larger LDL-C reduction. These data support the ACC/AHA recommendation to monitor LDL-C response among patients initiating statins.
authors.affiliation: Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, 2101 East Jefferson St, 4W, Rockville, MD 20852. E-mail: Suma.Vupputuri@kp.org.
authors.forename: Suma
authors.initials: S
authors.lastname: Vupputuri
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Joski
authors.forename: Ryan
authors.initials: R
authors.lastname: Kilpatrick
authors.forename: J Michael
authors.initials: JM
authors.lastname: Woolley
authors.forename: Brandi E
authors.initials: BE
authors.lastname: Robinson
authors.forename: Michael E
authors.initials: ME
authors.lastname: Farkouh
authors.forename: Huifeng
authors.initials: H
authors.lastname: Yun
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000187:drug effects; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy*; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D020380:Needs Assessment; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States; D016903:Drug Monitoring
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors