Evidence map›Paper›PMID 33407522›Full record

ArticleLipids in health and disease2021

LDL-cholesterol change and goal attainment following statin intensity titration among Asians in primary care: a retrospective cohort study.

Hao Sen Andrew Fang, Qiao Gao, Mong Li Lee, Wynne Hsu, Ngiap Chuan Tan

Open access · goldAbstract read
In one paragraph

Article in Lipids in health and disease, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
1.5field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 7 citations in OpenAlex.

  1. Article
  2. Observational
  3. Article
  4. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

Hao Sen Andrew FangSingHealth Polyclinics, SingHealth, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, P.O. 150167, Singapore. andrew.fang.h.s@singhealth.com.sg.ORCID http://orcid.org/0000-0003-4761-9356
Qiao GaoInstitute of Data Science, National University of Singapore, Singapore, Singapore.
Mong Li LeeSchool of Computing, National University of Singapore, Singapore, Singapore.
Wynne HsuSchool of Computing, National University of Singapore, Singapore, Singapore.
Ngiap Chuan TanSingHealth Polyclinics, SingHealth, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, P.O. 150167, Singapore.
National University of Singapore · SGSingHealth · SGSingHealth Duke-NUS Academic Medical Centre · SG

Funding

National Research Foundation Singapore AISG-GC-2019-001
6 · The paper itself

Abstract

backgroundClinical trials have demonstrated that either initiating or up-titrating a statin dose substantially reduce Low-Density Lipoprotein-Cholesterol (LDL-C) levels. However, statin adherence in actual practice tends to be suboptimal, leading to diminished effectiveness. This study aims to use real-world data to determine the effect on LDL-C levels and LDL-C goal attainment rates, when selected statins are titrated in Asian patients.

methodsA retrospective cohort study over a 5-year period, from April 2014 to March 2019 was conducted on a cohort of multi-ethnic adult Asian patients with clinical diagnosis of Dyslipidaemia in a primary care clinic in Singapore. The statins were classified into low-intensity (LI), moderate-intensity (MI) and high-intensity (HI) groups according to the 2018 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guidelines. Patients were grouped into "No statin", "Non-titrators" and "Titrators" cohorts based on prescribing patterns. For the "Titrators" cohort, the mean percentage change in LDL-C and absolute change in LDL-C goal attainment rates were computed for each permutation of statin intensity titration.

resultsAmong the cohort of 11,499 patients, with a total of 266,762 visits, there were 1962 pairs of LDL-C values associated with a statin titration. Initiation of LI, MI and HI statin resulted in a lowering of LDL-C by 21.6% (95%CI = 18.9-24.3%), 28.9% (95%CI = 25.0-32.7%) and 25.2% (95%CI = 12.8-37.7%) respectively. These were comparatively lower than results from clinical trials (30 to 63%). The change of LDL-C levels due to up-titration, down-titration, and discontinuation were - 12.4% to - 28.9%, + 13.2% to + 24.6%, and + 18.1% to + 32.1% respectively. The improvement in LDL-C goal attainment ranged from 26.5% to 47.1% when statin intensity was up-titrated.

conclusionIn this study based on real-world data of Asian patients in primary care, it was shown that although statin titration substantially affected LDL-C levels and LDL-C goal attainment rates, the magnitude was lower than results reported from clinical trials. These results should be taken into consideration and provide further insight to clinicians when making statin adjustment recommendations in order to achieve LDL-C targets in clinical practice, particularly for Asian populations.

Indexed as

Asian PeoplePrimary Health CareAgedCholesterol, LDLFemaleGoalsHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedOdds RatioRetrospective StudiesRisk FactorsTreatment OutcomeCholesterol, LDLHydroxymethylglutaryl-CoA Reductase InhibitorsAsianGoal attainmentLDL-cholesterolPercentage changePrimary careReal-world dataStatin

Identifiers

PMID33407522
PMCPMC7788928
OpenAlexW3119805319

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.