Determinants of Treatment Modification in Hypercholesterolemic Patients.
BACKGROUND
There is a lack of knowledge of those contemporary factors associated with modifying subtherapeutic treatments in hypercholesterolemic patients. The aim of this study was to assess determinants of treatment modification in patients not attaining their low-density lipoprotein cholesterol goals.


METHODS
The CEntralized Pan-Asian survey on tHE Under-treatment of hypercholeSterolemia enrolled patients taking stable lipid-lowering medications. The study physicians then determined existing patient treatments, which were to be continued or modified when treatments failed. The patient questionnaire surveying patient attitudes and perceptions toward their hypercholesterolemia management was prospectively collected. The odds ratios (ORs) (95% confidence intervals) were calculated.


RESULTS
Among the 420 patients included for analysis, 35.7% were designated for planned treatment modification. Those patients assigned to treatment modification were more likely to have a family history of premature coronary heart disease (40% vs. 19%), an indication for secondary prevention (76% vs. 61%), elevated triglyceride (60% vs. 48%) and fasting sugar (84% vs. 67%), and were less adherent to their medications (29% vs. 12%) than patients assigned to treatment continuation. Patient recognition of treatment failure [OR, 1.82 (1.13-2.94)], the lower frequency of cholesterol checkup [OR, 2.40 (1.41-4.08)], patient satisfaction with provided cholesterol information [OR, 2.30 (1.21-4.39)], and their feelings toward cholesterol management [OR, 0.25 (0.10-0.62) and 3.80 (2.28-6.32)] for confusion and no strong feeling, respectively were determinants of the treatment modification assignment.


CONCLUSIONS
There was a large gap between evidence-based goals and modification of subtherapeutic treatments, particularly among patients with lower treatment satisfaction and better compliance. Our findings have emphasized the need to further reduce inertia in implementing hypercholesterolemia management.
School of Medicine, National Yang-Ming University.
Ko-Fan
KF
Wang
School of Medicine, National Yang-Ming University.
Cheng-Hsueh
CH
Wu
School of Medicine, National Yang-Ming University.
Chun-Chin
CC
Chang
School of Medicine, National Yang-Ming University; ; Department of Cardiology, Shin Kong Wu Ho-Su Memorial Hospital.
Lung-Ching
LC
Chen
School of Medicine, National Yang-Ming University; ; General Clinical Research Center; ; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
Kang-Ling
KL
Wang
School of Medicine, National Yang-Ming University.
Tse-Min
TM
Lu
School of Medicine, National Yang-Ming University; ; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
Shing-Jong
SJ
Lin
School of Medicine, National Yang-Ming University; ; General Clinical Research Center; ; Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
Chern-En
CE
Chiang
Clinical inertia; Epidemiology; Hypercholesterolemia; Low-density lipoprotein cholesterol; Treatment modification