Niacin and fibrate use among patients with high triglycerides and low high-density lipoprotein cholesterol

ABSTRACT

Background: National guidelines recommend treating low HDL and/or high triglycerides (TG) with adjunctive therapy that supplements statin monotherapy in patients with multiple cardiovascular disease (CVD) risk factors. Niacin and fibrates have been shown in clinical trials to be effective as adjunctive therapy for these lipid abnormalities.

Objective: To evaluate the pharmacologic treatment of low HDL and high TG in real-world practice by assessing a large managed-care population with CVD risk factors enrolled in a commercial health plan.

Research design and methods: Complete lipid panel results (LDL, HDL, TG) obtained between 1/1/2006 and 12/31/2006 (index lab) were available for all participants. Subjects were observed 180 days pre-index to determine which CVD risk factors were present (male aged 45+, female 55+, coronary heart disease, hypertension, diabetes mellitus). Patients whose LDL was at goal but who had low HDL and high TG were assessed for lipid treatment status by evaluating outpatient pharmacy claims 6 months pre- and post-index.

Results: Treatment with any lipid therapy increased for all risk groups, and by total risk factors, from pre-index to post-index. Use of fibrates and niacin, alone or in combination with a statin, also increased for all risk groups, and by total risk factors as well, but was below expectations based on guideline recommendations. For example, among patients with 4 risk factors, <20% of patients with low HDL/high TG received niacin and/or a fibrate post-index date.

Conclusions: Our results indicate that in actual clinical practice, niacin and fibrates are underutilized in the treatment of low HDL and high TG. The findings of this study must be considered within the limitations of database analysis as claims data are collected for the purpose of payment and not research.

Key words: :

• Anticholesteremic agents
• Cholesterol
• Coronary disease
• Dyslipidemias
• HDL
• Niacin
• Treatment outcome
• Triglycerides

Transparency

Declaration of funding

This study and the publication of this article was funded by Abbott Laboratories.

Declaration of financial/other relationships

D.L. has disclosed that he is an employee of Abbot Laboratories. V.Z. and J.M.S. have disclosed that they are employees of i3 Innovus. P.P.T. has disclosed that he is a consultant and a member of the speakers' bureau of Abbott, AstraZeneca, Merck, Schering-Plough and Pfizer.

All peer reviewers received honoraria for peer reviewing for CMRO. Peer Reviewer 1 has disclosed that he has no relevant financial relationships. Peer Reviewer 2 has disclosed that he is a stockholder of Merck & Co. Inc.

Acknowledgment

The study authors thank Victoria Porter, an employee of i3 Innovus, for her assistance with the preparation of this manuscript.