Determinants of lipid goal achievement in patients on extended-release nicotinic acid/laropiprant in primary care clinical practice

Abstract

Objectives:

To establish determinants of lipid goal attainment in primary care patients, with particular focus on participation in a disease management programme (DMP) on diabetes mellitus (DM) and/or coronary heart disease (CHD), with real-world practical relevance.

Methods:

The present analysis was based on an observational study in 2359 patients with dyslipidaemia or hypercholesterolaemia that were treated with nicotinic acid 1000 mg/laropiprant 20 mg (Tredaptive) one or two tablets daily. Subgroups were formed by DMP participation (DMP vs. no DMP). A stepwise logistic regression model with backward selection of variables was applied to investigate factors influencing the probability of reaching lipid goals. Follow-up was 23 ± 7 weeks.

Results:

Low density lipoprotein cholesterol (LDL-C) <100 mg/dl was achieved by 30.8% in DMP versus 26.8% (no DMP), high density lipoprotein (HDL-C) >40/50 mg/dl in 61.3% versus 66.1%, and triglycerides (TG) <150 mg/dl in 28.9% versus 31.7%. On multivariate analysis, age, sex, concomitant high-risk cardiovascular disease, or participation in a DMP appeared to have inconsistent effects on reaching LDL-C, HDL-C and TG goals. Likelihood to reach the LDL-C goal tended to be higher in males, in patients outside DMP, and in patients with DM or CHD, and those treated with 1 tablet (versus 2 tablets) extended release nicotinic acid 1000 mg/laropiprant 20 mg. The likelihood of reaching the HDL-C goal was higher in males and in patients without DM or DM+CHD (no effect of DMP). The likelihood of reaching the TG goals was higher in females, in patients outside DMP, and in patients with DM and/or CHD. Limitations include potential bias due to study design, physician and patient selection, and missing values at follow-up.

Conclusion:

DMP participation was not associated with overall improved lipid goal attainment. Physicians cannot predict the magnitude of effects of newly initiated lipid modifying therapy based on baseline characteristics of their patients.

Keywords::

• Cholesterol
• Determinants
• Disease management programmes
• Drug treatment
• Dyslipidaemia
• Hypercholesterolaemia
• Observation
• Predictors
• Primary care
• triglycerides

Transparency

Declaration of funding

The study was funded by Merck Sharp & Dohme GmbH, Haar, Germany.

Declaration of financial/other relationships

W.D. and E.S.-T. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article. C.B. and S.H. have disclosed that they are employees of MSD Pharma, Munich, Germany. D.P. has disclosed that he is a consultant for MSD Pharma GmbH, Haar, Germany.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

The analysis was performed by D. Deutsch of MedPharmTec, Munich, Germany, and paid for by MSD Pharma.

Notes

*Tredaptive is a registered trade name of Merck Sharp & Dohme GmbH, Haar, Germany.

*Tredaptive is a registered trade name of Merck Sharp & Dohme GmbH, Haar, Germany.