Current status of cholesterol goal attainment after statin therapy among patients with hypercholesterolemia in Asian countries and region: the Return on Expenditure Achieved for Lipid Therapy in Asia (REALITY-Asia) study

ABSTRACT

Background: Data on achieving National Cholesterol Education Program Adult Treatment Panel III (ATP III) goals in Asia are limited.

Objective: To examine treatment patterns, goal attainment, and factors influencing treatment among patients in 6 Asian countries who were taking statins.

Methods: A retrospective cohort study was conducted in China, Korea, Malaysia, Singapore, Taiwan, and Thailand, where 437 physicians (41% cardiologists) recruited adults with hypercholesterolemia newly initiated on statin monotherapy.

Results: Of 2622 patients meeting inclusion and exclusion criteria, approximately 66% had coronary heart disease (CHD)/diabetes mellitus, 24% had no CHD but ≥2 risk factors, and 10% had no CHD and <2 risk factors. Most patients (∼90%) received statins at medium or lower equipotency doses. Across all cardiovascular risk categories, 48% of patients attained ATP III targets for low-density lipoprotein cholesterol (LDL-C), including 38% of those with CHD/diabetes (goal: <100 mg/dL), 62% of those without CHD but with ≥2 risk factors (goal: <130 mg/dL), and 81% of those without CHD and <2 risk factors (goal: <160 mg/dL). Most patients who achieved goals did so within the first 3 months. Increasing age (odds ratio (OR) = 1.015 per 1-year increment; 95% confidence interval (CI) = 1.005–1.206; p = 0.0038) and initial statin potency (OR = 2.253; 95% CI = 1.364–3.722; p = 0.0015) were directly associated with goal attainment, whereas increased cardiovascular risk (OR=0.085; 95% CI = 0.053–0.134; p < 0.0001 for CHD/diabetes mellitus at baseline compared with <2 risk factors,) and baseline LDL-C (OR = 0.990; 95% CI = 0.987–0.993); p < 0.0001 per 1-mg/dL increment) were inversely associated with LDL-C goal achievement. Limitations of this study include potential differences in treatment settings and cardiovascular risk factors between different countries and centers. In addition, the effects on cholesterol goal achievement of concomitant changes in lifestyle were not assessed.

Conclusion: LDL-C goal attainment is low in Asians, particularly those with CHD/diabetes. More effective patient monitoring, treatments, including combining regimens and dose titration, and adherence to these treatments along with therapeutic lifestyle counseling may facilitate goal attainment.

Key words: :

• Cholesterol
• Coronary disease
• Hydroxymethylglutaryl coenzyme A inhibitors
• Treatment outcome

Acknowledgments

Declaration of interest: This study and its report were supported by MSP (Merck/Schering-Plough) Singapore Company LLC. YW is Principal Investigator for the Second Survey on Status in Clinical Control of Dyslipidemia in China and Co-Principal Investigator of the present study, both of which were funded by the study sponsor or its affiliates (Schering-Plough China Ltd. and MSD China). QZ is an employee of Merck & Co, Inc. PY has received honoraria from Merck Sharp & Dohme (I.A.) Corp. and Novartis Pharmaceuticals Corp. for speaking at medical congresses. H-SK, S-JL, CD, RZ, and LZ have no financial interests to disclose.

Assistance in manuscript preparation was funded by MSP and was provided by SW Gutkin, Rete Biomedical Communications Corp. (Ridgewood, NJ, USA). E Alemao of Merck & Co., Inc. (Whitehouse Station, NJ, USA), assisted in data acquisition and analyses and E Alemao and WC Gerth of Merck & Co., Inc. reviewed and provided feedback on the manuscript. S Kwon (MSD-Asia Pacific) provided technical and logistical support.