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Articles by Ross J. Simpson
Total Records ( 3 ) for Ross J. Simpson
  Rachel H. Kon , Mark W. Russo , Bridget Ory , Phil Mendys and Ross J. Simpson
 

Background

Statins are commonly used to reduce the risk of heart attacks and strokes. Despite the benefit and limited risks in properly identified patients, clinicians are often challenged by patient acceptance and adherence to these medications.

Objectives

To assess if patients and physicians may have unfounded safety concerns about hepatotoxicity from these medications, we surveyed physicians and patients.

Results

We found inconsistent liver function-monitoring practices as well as exaggerated fears of statin-induced hepatotoxicity. Patients who received risk information from their physician were more likely to accurately estimate hepatotoxic risk than patients receiving such information from other sources.

Conclusions

We believe these misperceptions about the relative risk and benefits of statin therapy are propagated by direct-to-consumer advertising, which may emphasize potential adverse events relative to treatment benefits. These perceptions are likely to adversely affect statin adherence, and may be addressed by patient education.

  Ross J. Simpson and Philip Mendys
 

Background

In clinical practice, medication adherence and persistence are important for disease management and can significantly improve outcomes and enhance the quality of patient care. Quantifying the relationship between medication adherence/persistence and clinical outcomes with statins can serve as an important therapeutic model and complement our understanding of the critical relationship between medication use and improved patient care.

Methods and Results

A PubMed search was conducted for literature published between 1999 and 2009 using the terms adherence, compliance, HMG CoA, nonadherence, noncompliance, persistency, persistence, and statin. Data on the direct relationship between adherence or persistence to statin monotherapy and clinical outcomes were extracted. A total of 19 articles met the inclusion criteria, including the clinical impact of adherence (n = 15) and persistence (n = 4). High levels of adherence were associated with reductions in adverse clinical outcomes, including all-cause mortality and fatal and nonfatal cardiovascular events; the most consistent benefits were witnessed at adherence levels 80% or greater. In primary prevention cohorts, clinical benefits were seen after 1 year of therapy. Longer durations of treatment were associated with incremental improvements in clinical outcomes as length of therapy increased.

Conclusions

High levels of adherence and longer durations of persistence with statins are associated with progressively increasing clinical benefits in primary and secondary prevention patient populations at risk for cardiovascular events. Efforts to improve adherence and persistence are warranted.

  Ross J. Simpson , Kaan Tunceli , Dena R. Ramey , David R. Neff , David M. Kern , Hui-Min Hsieh , Debra A. Wertz , Judith J. Stephenson , Elizabeth Marrett , Joanne E. Tomassini and Terry A. Jacobson
 

Back ground

For high-risk patients who do not achieve guideline-recommended LDL-C levels, more intensive treatment including statin-uptitration to higher doses or potency, as well as combination therapy may be considered. A better understanding of statin treatment patterns in real-world clinical practice may contribute to improved lipid-lowering management in these patients.

Objective

We determined treatment pattern changes among patients with high risk of cardiovascular disease who were not at low-density lipoprotein cholesterol (LDL-C) goal on statin monotherapy.

Methods

Treatment pattern changes were evaluated among patients newly initiated on statins between January 1, 2006, and August 31, 2009, in the HealthCore Integrated Research Database. Rates and mean time to first and second treatment changes were examined in patients with claims for coronary heart disease (CHD), atherosclerotic vascular disease (AVD), and diabetes mellitus during 12 months before index, who were not at LDL-C <70 mg/dL at their first-eligible LDL-C test (≥4 weeks after index). Therapy change was assessed for 12 months after the LDL-C result.

Results

Of 11,473 eligible subjects, 61.3% had diabetes, 26.6% had CHD and AVD, and 12.1% had CHD and AVD and diabetes. At index, patients were prescribed medium-potency levels of statins, including simvastatin (44.7%), atorvastatin (31.5%), and other statins (23.8%). Mean ± SD LDL-C before statin initiation was 138 ± 34 mg/dL, and at the first-eligible LDL-C result after index, it was 101 ± 25 mg/dL. During follow-up, 7444 subjects (64.9%) experienced a first treatment change, with mean time to change of 93.8 ± 92 days, whereas 4029 (36.1%) had no treatment change. Discontinuation of index therapy occurred in 46.9% of subjects and medication switches or titration in 18.0% (index statin titration, switch to other statins, other lipid-lowering therapies [LLT], including ezetimibe). Of the discontinuers, 27.4% restarted LLT. Of subjects with a first treatment change who did not discontinue, 48.9% experienced a second therapy change. Results were similar between the 3 high-risk groups.

Conclusions

In this managed-care setting, among patients with high risk of cardiovascular disease who were not at LDL-C goal, statins were usually started at medium-potency doses without being titrated up, whereas nearly one-half had a discontinuation of LLT within 12 months. These treatment patterns indicate the need for better patient and provider education as well as other system-wide modifications to improve medication adherence.

 
 
 
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