Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India

Surendra Shamkant Borgharkar; Soma Soumitra Das

doi:doi:10.11648/j.ajhr.20200803.11

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Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India

Surendra Shamkant Borgharkar, Soma Soumitra Das

Published in American Journal of Health Research (Volume 8, Issue 3)

Received: 13 April 2020 Accepted: 30 April 2020 Published: 28 May 2020

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Abstract

To evaluate concordance to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline on treatment of blood cholesterol for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. Concordance to 2013 ACC/AHA guideline was assessed by retrospectively analyzing statin therapy prescribing practice as per ASCVD risk score in four statin-benefit groups in 23,295 patients aged 40-79 years from health facilities across India between 2017 and 2018. Mean (±SD) age of patients was 58.9 (±9.2) years; 62% were men; 60% (n=14,070) had clinical ASCVD. Among patients without ASCVD (n=7,122), 3.9% (n=278) had low-density lipoprotein-cholesterol (LDL-C) ≥190 mg/dL, 94.0% (n=6,694) had diabetes mellitus and 2.1% (n=150) patients had 10-year ASCVD risk ≥7.5%. Among 18,795 patients (81%) eligible for high-intensity statins, only 34% were concordant whereas 63% were treated with moderate-intensity statins. Among 2,290 patients eligible for moderate-intensity statins, 76% were concordant and 18% received high-intensity statins. Among patients with ASCVD (<75 years), 43% received high-intensity statins, 55% received moderate-intensity statins, while 2% did not receive statins. Among patients with diabetes and ASCVD risk <7.5%, 86% received moderate-intensity statins, but those with risk >7.5%, 83% remained under-treated. Most patients (82%) with LDL-C >190 mg/dL were prescribed with moderate-intensity statins. Most patients were receiving statins at dose non-concordant to 2013 ACC/AHA guideline, reflecting gaps in real-world practice of prescribing statins for primary and secondary prevention of ASCVD. Addressing care gaps and promoting compliance to optimize statin therapy will help reduce cardiovascular disease, especially in high-risk population among South Asians.

Published in	American Journal of Health Research (Volume 8, Issue 3)
DOI	10.11648/j.ajhr.20200803.11
Page(s)	18-25
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Cardiovascular Disease, Statin Therapy, Real-world Evidence, Low-density Lipoprotein-Cholesterol, Cholesterol Guidelines

References

[1]	World Health Organization. Cardiovascular diseases (CVDs) [Internet]. Geneva: World Health Organization; 2017 [cited April 2019]. Available from: https://www.who.int/cardiovascular_diseases/en/ files/7/en.html.
[2]	Yusuf S, Rangarajan S, Teo K, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med 2014; 371 (9): 818-27.
[3]	Prabhakaran D, Jeemon P, Roy A. Cardiovascular diseases in India: current epidemiology and future directions. Circulation 2016; 133 (16): 1605-20.
[4]	Prabhakaran D, Jeemon P, Sharma M, et al. The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990–2016. Lancet Glob Health 2018; 6 (12): 1339-51.
[5]	Volgman AS, Palaniappan LS, Aggarwal NT, et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation 2018; 138 (1): 1-34.
[6]	Gupta R, Rao RS, Misra A, et al. Recent trends in epidemiology of dyslipidemias in India. Indian Heart J 2017; 69 (3): 382-92.
[7]	Vaduganathan M, Venkataramani AS, Bhatt DL. Moving Toward Global Primordial Prevention in Cardiovascular Disease: The Heart of the Matter. J Am Coll Cardiol 2015; 66 (14): 1535-7.
[8]	Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63 (25 Part B): 2889-934.
[9]	Gupta R, Lodha S, Sharma KK, et al. Evaluation of statin prescriptions in type 2 diabetes: India Heart Watch-2. BMJ Open Diabetes Res Care 2016; 4 (1): e000275.
[10]	American Diabetes Association. Introduction: Standards of Medical Care in Diabetes—2018. Diabetes Care 2018; 41 (1): 1-S2.
[11]	Misra A, Chowbey P, Makkar BM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009; 57 (2): 163-70.
[12]	Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003; 289 (19): 2560-71.
[13]	Lipsy RJ. The National Cholesterol Education Program Adult Treatment Panel III guidelines. J Manag Care Pharm 2003; 9 (1): 2–5.
[14]	Ference BA, Graham I, Tokgozoglu L, et al. Impact of Lipids on Cardiovascular Health: JACC Health Promotion Series. J Am Coll Cardiol 2018; 72 (10): 1141-56.
[15]	Guptha S, Gupta R, Deedwania P, et al. Cholesterol lipoproteins and prevalence of dyslipidemias in urban Asian Indians: A cross sectional study. Indian Heart J 2014; 66 (3): 280-8.
[16]	Yang Q, Zhong Y, Gillespie C, et al. Assessing potential population impact of statin treatment for primary prevention of atherosclerotic cardiovascular diseases in the USA: population-based modelling study. BMJ Open 2017; 7 (1): e011684.
[17]	Vashitz G, Meyer J, Parmet Y, et al. Physician adherence to the dyslipidemia guidelines is as challenging an issue as patient adherence. Fam Pract 2011; 28 (5): 524–31.
[18]	Maddox TM, Borden WB, Tang F, et al. Implications of the 2013 ACC/AHA cholesterol guidelines for adults in contemporary cardiovascular practice: insights from the NCDR PINNACLE registry. J Am Coll Cardiol 2014; 64 (21): 2183-92.
[19]	Wander GS, Jadhav UM, Chemburkar A, et al. Lipid management in India: a nationwide, cross-sectional physician survey. Lipids Health Dis 2017; 16 (1): 130.
[20]	Giustino G, Colantonio LD, Brown TM, et al. Titration to high-intensity statin therapy following acute myocardial infarction in patients with and without diabetes mellitus. Cardiovasc Drugs Ther 2018; 32 (5): 453-61.
[21]	Graham IM, Stewart M, Hertog MGL. Factors impeding the implementation of cardiovascular prevention guidelines: findings from a survey conducted by the European Society of Cardiology. Eur J Cardiovasc Prev Rehabil 2006; 13 (5): 839-45.
[22]	Elisabeth AB, Denig P, van Vliet T, et al. Reasons of general practitioners for not prescribing lipid-lowering medication to patients with diabetes: a qualitative study. BMC Fam Pract 2009; 10 (1): 24.
[23]	Clough JD, Martin SS, Navar AM, et al. Association of primary care providers’ beliefs of statins for primary prevention and statin prescription. J Am Heart Assoc 2019; 8 (3): e010241.
[24]	Setia S, Fung SS, Waters DD. Doctors' knowledge, attitudes, and compliance with 2013 ACC/AHA guidelines for prevention of atherosclerotic cardiovascular disease in Singapore. Vasc Health Risk Manag 2015; 11: 303-10.
[25]	Taguchi I, Iimuro S, Iwata H, et al. High-Dose Versus Low-Dose Pitavastatin in Japanese Patients With Stable Coronary Artery Disease (REAL-CAD): A Randomized Superiority Trial. Circulation 2018; 137 (19): 1997-2009.
[26]	Tan CE, Loh LM, Tai ES. Do Singapore patients require lower doses of statins? The SGH Lipid Clinic experience. Singapore Med J 2003; 44 (12): 635-8.
[27]	Nguyen T, Nguyen HQ, Widyakusuma NN, et al. Enhancing prescribing of guideline-recommended medications for ischaemic heart diseases: a systematic review and meta-analysis of interventions targeted at healthcare professionals. BMJ Open 2018; 8 (1): e018271.
[28]	Ridker Paul M. How Common Is Residual Inflammatory Risk? Circ Res. 2017; 120 (4): 617-9.
[29]	Menon VP, Edathadathil F, Sathyapalan D, et al. Assessment of 2013 AHA/ACC ASCVD risk scores with behavioral characteristics of an urban cohort in India: Preliminary analysis of Noncommunicable disease Initiatives and Research at AMrita (NIRAM) study. Medicine 2016; 95 (49): e5542.
[30]	Hong KN, Fuster V, Rosenson RS, et al. How Low to Go With Glucose, Cholesterol, and Blood Pressure in Primary Prevention of CVD. J Am Coll Cardiol 2017; 70 (17): 2171-85.

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APA Style

Surendra Shamkant Borgharkar, Soma Soumitra Das. (2020). Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India. American Journal of Health Research, 8(3), 18-25. https://doi.org/10.11648/j.ajhr.20200803.11

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ACS Style

Surendra Shamkant Borgharkar; Soma Soumitra Das. Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India. Am. J. Health Res. 2020, 8(3), 18-25. doi: 10.11648/j.ajhr.20200803.11

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AMA Style

Surendra Shamkant Borgharkar, Soma Soumitra Das. Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India. Am J Health Res. 2020;8(3):18-25. doi: 10.11648/j.ajhr.20200803.11

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@article{10.11648/j.ajhr.20200803.11,
  author = {Surendra Shamkant Borgharkar and Soma Soumitra Das},
  title = {Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India},
  journal = {American Journal of Health Research},
  volume = {8},
  number = {3},
  pages = {18-25},
  doi = {10.11648/j.ajhr.20200803.11},
  url = {https://doi.org/10.11648/j.ajhr.20200803.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20200803.11},
  abstract = {To evaluate concordance to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline on treatment of blood cholesterol for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. Concordance to 2013 ACC/AHA guideline was assessed by retrospectively analyzing statin therapy prescribing practice as per ASCVD risk score in four statin-benefit groups in 23,295 patients aged 40-79 years from health facilities across India between 2017 and 2018. Mean (±SD) age of patients was 58.9 (±9.2) years; 62% were men; 60% (n=14,070) had clinical ASCVD. Among patients without ASCVD (n=7,122), 3.9% (n=278) had low-density lipoprotein-cholesterol (LDL-C) ≥190 mg/dL, 94.0% (n=6,694) had diabetes mellitus and 2.1% (n=150) patients had 10-year ASCVD risk ≥7.5%. Among 18,795 patients (81%) eligible for high-intensity statins, only 34% were concordant whereas 63% were treated with moderate-intensity statins. Among 2,290 patients eligible for moderate-intensity statins, 76% were concordant and 18% received high-intensity statins. Among patients with ASCVD (7.5%, 83% remained under-treated. Most patients (82%) with LDL-C >190 mg/dL were prescribed with moderate-intensity statins. Most patients were receiving statins at dose non-concordant to 2013 ACC/AHA guideline, reflecting gaps in real-world practice of prescribing statins for primary and secondary prevention of ASCVD. Addressing care gaps and promoting compliance to optimize statin therapy will help reduce cardiovascular disease, especially in high-risk population among South Asians.},
 year = {2020}
}

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TY  - JOUR
T1  - Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India
AU  - Surendra Shamkant Borgharkar
AU  - Soma Soumitra Das
Y1  - 2020/05/28
PY  - 2020
N1  - https://doi.org/10.11648/j.ajhr.20200803.11
DO  - 10.11648/j.ajhr.20200803.11
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 18
EP  - 25
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20200803.11
AB  - To evaluate concordance to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline on treatment of blood cholesterol for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. Concordance to 2013 ACC/AHA guideline was assessed by retrospectively analyzing statin therapy prescribing practice as per ASCVD risk score in four statin-benefit groups in 23,295 patients aged 40-79 years from health facilities across India between 2017 and 2018. Mean (±SD) age of patients was 58.9 (±9.2) years; 62% were men; 60% (n=14,070) had clinical ASCVD. Among patients without ASCVD (n=7,122), 3.9% (n=278) had low-density lipoprotein-cholesterol (LDL-C) ≥190 mg/dL, 94.0% (n=6,694) had diabetes mellitus and 2.1% (n=150) patients had 10-year ASCVD risk ≥7.5%. Among 18,795 patients (81%) eligible for high-intensity statins, only 34% were concordant whereas 63% were treated with moderate-intensity statins. Among 2,290 patients eligible for moderate-intensity statins, 76% were concordant and 18% received high-intensity statins. Among patients with ASCVD (7.5%, 83% remained under-treated. Most patients (82%) with LDL-C >190 mg/dL were prescribed with moderate-intensity statins. Most patients were receiving statins at dose non-concordant to 2013 ACC/AHA guideline, reflecting gaps in real-world practice of prescribing statins for primary and secondary prevention of ASCVD. Addressing care gaps and promoting compliance to optimize statin therapy will help reduce cardiovascular disease, especially in high-risk population among South Asians.
VL  - 8
IS  - 3
ER  -

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Author Information

Surendra Shamkant Borgharkar

Sun Pharmaceutical Industries Ltd., Mumbai, India
Soma Soumitra Das

Covance Scientific Services & Solutions Pvt. Ltd., Pune, India

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APA Style

Surendra Shamkant Borgharkar, Soma Soumitra Das. (2020). Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India. American Journal of Health Research, 8(3), 18-25. https://doi.org/10.11648/j.ajhr.20200803.11

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ACS Style

Surendra Shamkant Borgharkar; Soma Soumitra Das. Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India. Am. J. Health Res. 2020, 8(3), 18-25. doi: 10.11648/j.ajhr.20200803.11

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AMA Style

Surendra Shamkant Borgharkar, Soma Soumitra Das. Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India. Am J Health Res. 2020;8(3):18-25. doi: 10.11648/j.ajhr.20200803.11

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@article{10.11648/j.ajhr.20200803.11,
  author = {Surendra Shamkant Borgharkar and Soma Soumitra Das},
  title = {Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India},
  journal = {American Journal of Health Research},
  volume = {8},
  number = {3},
  pages = {18-25},
  doi = {10.11648/j.ajhr.20200803.11},
  url = {https://doi.org/10.11648/j.ajhr.20200803.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20200803.11},
  abstract = {To evaluate concordance to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline on treatment of blood cholesterol for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. Concordance to 2013 ACC/AHA guideline was assessed by retrospectively analyzing statin therapy prescribing practice as per ASCVD risk score in four statin-benefit groups in 23,295 patients aged 40-79 years from health facilities across India between 2017 and 2018. Mean (±SD) age of patients was 58.9 (±9.2) years; 62% were men; 60% (n=14,070) had clinical ASCVD. Among patients without ASCVD (n=7,122), 3.9% (n=278) had low-density lipoprotein-cholesterol (LDL-C) ≥190 mg/dL, 94.0% (n=6,694) had diabetes mellitus and 2.1% (n=150) patients had 10-year ASCVD risk ≥7.5%. Among 18,795 patients (81%) eligible for high-intensity statins, only 34% were concordant whereas 63% were treated with moderate-intensity statins. Among 2,290 patients eligible for moderate-intensity statins, 76% were concordant and 18% received high-intensity statins. Among patients with ASCVD (7.5%, 83% remained under-treated. Most patients (82%) with LDL-C >190 mg/dL were prescribed with moderate-intensity statins. Most patients were receiving statins at dose non-concordant to 2013 ACC/AHA guideline, reflecting gaps in real-world practice of prescribing statins for primary and secondary prevention of ASCVD. Addressing care gaps and promoting compliance to optimize statin therapy will help reduce cardiovascular disease, especially in high-risk population among South Asians.},
 year = {2020}
}

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TY  - JOUR
T1  - Concordance to Guideline-recommended Statin Therapy: Real-world Evidence from India
AU  - Surendra Shamkant Borgharkar
AU  - Soma Soumitra Das
Y1  - 2020/05/28
PY  - 2020
N1  - https://doi.org/10.11648/j.ajhr.20200803.11
DO  - 10.11648/j.ajhr.20200803.11
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 18
EP  - 25
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20200803.11
AB  - To evaluate concordance to the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline on treatment of blood cholesterol for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) in India. Concordance to 2013 ACC/AHA guideline was assessed by retrospectively analyzing statin therapy prescribing practice as per ASCVD risk score in four statin-benefit groups in 23,295 patients aged 40-79 years from health facilities across India between 2017 and 2018. Mean (±SD) age of patients was 58.9 (±9.2) years; 62% were men; 60% (n=14,070) had clinical ASCVD. Among patients without ASCVD (n=7,122), 3.9% (n=278) had low-density lipoprotein-cholesterol (LDL-C) ≥190 mg/dL, 94.0% (n=6,694) had diabetes mellitus and 2.1% (n=150) patients had 10-year ASCVD risk ≥7.5%. Among 18,795 patients (81%) eligible for high-intensity statins, only 34% were concordant whereas 63% were treated with moderate-intensity statins. Among 2,290 patients eligible for moderate-intensity statins, 76% were concordant and 18% received high-intensity statins. Among patients with ASCVD (7.5%, 83% remained under-treated. Most patients (82%) with LDL-C >190 mg/dL were prescribed with moderate-intensity statins. Most patients were receiving statins at dose non-concordant to 2013 ACC/AHA guideline, reflecting gaps in real-world practice of prescribing statins for primary and secondary prevention of ASCVD. Addressing care gaps and promoting compliance to optimize statin therapy will help reduce cardiovascular disease, especially in high-risk population among South Asians.
VL  - 8
IS  - 3
ER  -

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