METHODS: Claims data from a large US managed care organization from July 1, 1998, through June 30, 2000, were analyzed for adult members with continuous enrollment, >or=1
prescription drug claim, >or=2 sets of fasting
low-density lipoprotein cholesterol (
LDL-C) laboratory results, and no
lipid-lowering prescription claims at any time <or=12 months before the date of the first set of
LDL-C laboratory results. Relative
lipid-lowering regimen efficacy categories were created based on percentage reduction in
LDL-C listed in product package inserts (low, <or=30%; moderate, 31%-40%; high, >or=41%). Multiple regression and logistic regression models were developed to identify significant predictors of percentage change in
LDL-C from baseline and of >or=10% reduction in
LDL-C.
RESULTS: A total of 6247 members met the inclusion criteria. The mean (SD) age was 59.6 (12.4) years (range, 21-93 years), and 3003 individuals (48.1%) were women. Furthermore, 337 members (5.4%) received high-efficacy
statins, 2633 (42.1%) received moderate-efficacy
statins, 934 (15.0%) received low-efficacy
statins, and 86 (1.4%) received low-efficacy
lipid-lowering drugs from other therapeutic classes during the study period. Compliance with
therapy was high (range, 85%-92%), and upward titration of
therapy was found in only 160 members (2.6%). Multiple regression analysis indicated that receiving
statin therapy compared with other
lipid-lowering
therapy was a significant predictor of percentage reduction in
LDL-C (P < 0.001). Logistic regression analysis indicated that compared with high-efficacy
statin regimens, low-efficacy
statin regimens (odds ratio [OR] = 0.619; 95% CI, 0.436-0.877) and low-efficacy regimens from other therapeutic classes (OR = 0.171; 95% CI, 0.099-0.295) were less effective in lowering
LDL-C by >or=10%. Similar results were observed for subanalyses of subjects with
diabetes mellitus or
coronary heart disease (CHD); individuals who received more efficacious
statin regimens were more likely to reach the National
Cholesterol Education Program Adult Treatment Panel II
LDL-C goal of <or=100 mg/dL (P < 0.05 for moderate- or low-efficacy regimens vs high-efficacy
statins in each model).
CONCLUSION: The results of the present study suggest that improvement is needed in
hyperlipidemia management, especially in identification and use of
lipid-lowering
therapy in individuals at high risk for CHD.