Doctors’ knowledge, attitudes, and compliance with 2013 ACC/AHA guidelines for prevention of atherosclerotic cardiovascular disease in Singapore

Figures & data

Table 1 Eligibility criteria for physicians to be included in the qualitative and quantitative surveys

Eligibility criteria
Qualitative survey
• Seen 30 or more patients in the past month
• Spent 50% or more time in a private setting
• Prescribed branded atorvastatin and rosuvastatin in the past 12 months
• Prescribed cholesterol-lowering medications to at least five (in the case of GPs) to 20 (in the case of cardiologists, endocrinologists) patients in the past month
• In the case of GPs, to have practiced between 3 and 30 years (inclusive)
• Cardiologists and endocrinologists had personally made decisions about dyslipidemia treatment for patients
Quantitative survey
• Required to have at least 3 years of clinical practice
• Prescribed cholesterol-lowering medications to at least 50 patients in the past month
• Personally made decisions about dyslipidemia treatment for patients
• Not working with a pharmaceutical company or health care manufacturer, serving as a clinical investigator, conducting clinical research, or providing consulting services in any paid capacity

Abbreviation: GPs, general practitioners.

Table 2 Physicians’ agreement with statements from 2013 ACC/AHA guidelines (results from qualitative stage)

Parameters	Number of physicians (n =19) who:
	Agree	Disagree	Remain neutral
Definition of high-intensity, moderate-intensity, and low-intensity statin therapy	7	11	1
Atorvastatin 40–80 mg and rosuvastatin 20–40 mg as the medication of high-intensity statin therapy	9	10	–
Four groups of individualsa would benefit from moderate-to high-intensity statin therapy	8	11	–
No data supporting the routine use of nonstatin drugs (eg, ezetimibe) combined with statin therapy to further reduce ascVD events	10	8	1

Note:

a Patients with: atherosclerotic cardiovascular disease; LDL, 190 mg/dL or higher; high-risk T2D aged 40–75 years; 10-year risk of CVD ≥7.5%, 40–75 years.

Abbreviations: ACC/AHA, American College of Cardiology and American Heart Association; ASCVD, atherosclerotic cardiovascular disease; CVD, cardiovascular disease; LDL, low-density lipoprotein; T2D, type 2 diabetes.

Figure 1 Patients on statins by concomitant condition.

Notes: ^aAverage number of patients on statins by concomitant condition: 180 diabetes, 171 hypertension, 113 CHD, 55 ACS, 54 CKD, 43 history of stroke. Base: all respondents (n=66). Generic rosuvastatin was not available when the study was conducted. Other medications include ezetimibe, fenofibrates, fluvastatin, pravastatin, etc.
Abbreviations: ACS, acute coronary syndrome; CHD, coronary heart disease; CKD, chronic kidney disease.

Table 3 Dyslipidemia patient grouping based on 2013 ACC/AHA guidelines

By specialty	Clinical ASCVD		Primary LDL ≥190 mg/dL		DM + LDL: 70–189 mg/dL		Risk of ASCVD ≥7.5% + LDL: 70–189 mg/dL
	Number of patients	% patients treated with high-intensity statin	Number of patients	% patients treated with high-intensity statin	Number of patients	% patients treated with high-intensity statin	Number of patients	% patients treated with high-intensity statin
GP (n=31)	48	42	64	39	114	35	69	38
Cardiologist (n=20)	133	41	61	28	178	25	105	37
Endocrinologist/nephrologist (n=15)	78	53	55	40	245	47	64	48

Note: Base: all respondents (n=66).

Abbreviations: ACC/AHA, American College of Cardiology and American Heart Association; ASCVD, atherosclerotic cardiovascular disease; DM, diabetes mellitus; GP, general practitioner; LDL, low-density lipoprotein.

Figure 2 Preferred dosages of atorvastatin and rosuvastatin for ASCVD and DM management.

Notes: Base: all respondents prescribing in the past 3 months. Asked only for branded atorvastatin and branded rosuvastatin. Generic rosuvastatin was not available when the study was conducted.
Abbreviations: ASCVD, atherosclerotic cardiovascular disease; DM, diabetes mellitus.

Table 4 Patient profile for atorvastatin and rosuvastatina

	Atorvastatin 20–40 mg	Atorvastatin 80 mg	Rosuvastatin 10–20 mg	Rosuvastatin 40 mg
Age	Not a factor	Not a factor	Not a factor	Not a factor
Risk factors	ACS	ACS	CHD	ACS
	CHD	CHD		CHD
LDL baseline (mg/dL)	130–159	160–189	130–159	160–189
	160–189		160–189
LDL target (lower to …)	≥50%	≥50%	≥50%	≥50%
Line of treatment	First line	Second line Third line and above	First line	Second line Third line and above

Notes: Base: all respondents (n=66).

a Asked only for branded atorvastatin and branded rosuvastatin. Generic rosuvastatin was not available when the study was conducted.

Abbreviations: ACS, acute coronary syndrome; CHD, coronary heart disease; LDL, low-density lipoprotein.