UK GP Success In Fight Against Cholesterol

Real life data from over 100 GP practices across the UK presented this week has shown that a greater proportion of patients with diabetes suffering from hypercholesterolemia were able to achieve the QOF target total cholesterol levels when treated with CRESTOR (rosuvastatin) 10mg compared to prior statin treatment.1


The audit results, presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 10th Annual Congress, show that 85% of patients treated with rosuvastatin 10mg achieved the QOF target cholesterol level (TC -5mmol/L). Importantly, a greater proportion of patients achieved the target cholesterol level with rosuvastatin 10mg compared with previous treatment, including those who had previously failed to reach targets when previously treated with other statins most commonly atorvastatin and simvastatin, across the dose range.1


Dr George Kassianos, GP, Bracknell, and steering group chair for the study commented: "These results tell us GPs what we need to know. Following NICE recommendations, the emphasis is on cost-effective strategies for reaching cholesterol targets in an NHS setting. Simvastatin is the first-line treatment for the majority of patients, but what do we do if patients do not achieve cholesterol targets with simvastatin? This GP practice data from across the country goes beyond clinical trials to show what we can actually achieve in real life practice when using rosuvastatin 10mg 'second-line'."


Success for UK GPs: Key findings from the Clinical Effectiveness Review Programme1


- 83% of patients changed from another statin treatment to rosuvastatin 10mg achieved the QOF cholesterol target compared to 38% on their prior statin treatment


- Significant reductions in TC and LDL-C were observed on rosuvastatin 10mg compared to prior treatment in patients new to therapy or who have changed therapy


Something to feel proud of:


Dr George Kassianos, GP, Bracknell, and contributor to the study commented: "These results demonstrate GPs all across the country are striving for and achieving best practice, getting even the most challenging patients to target-something to be proud of. It shows that treatment with low doses of rosuvastatin can help the majority of even the most difficult to treat patients that have failed to achieve the clinical target."


Dr Marc Evans, Consultant Diabetologist, Wales and contributor to the study, added: "It is of absolute importance that at the very least patients are reaching the cholesterol goals set out in the QOF framework. The results seen in this study are consistent with those we have seen in randomised controlled trials and adds to the weight of evidence supporting the use of rosuvastatin in patients who have failed to reach target on simvastatin."















This observational study brought together data from local audits in the Crestor Effectiveness Review Programme which reviewed the achievement of national cholesterol targets in diabetic patients with hypercholesterolemia treated with rosuvastatin 10mg in the UK general practice, either statin na??ve or previously treated with another statin. Following the UK General Medical Services Quality Outcomes Framework (QOF) set target of -5mmol/L total cholesterol (TC) as an audit standard for diabetes, permission to analyse anonymised date was granted by 101/150 practices who had completed audits before 2006.1


Cholesterol test results for 2,868 patients across the UK, before and after treatment with rosuvastatin 10mg, were analysed. Before starting treatment with rosuvastatin 10mg, 1,142 patients had previously been treated with another statin, most commonly simvastatin or atorvastatin. 1,726 patients had not used a statin before Crestor treatment.1


Rosuvastatin (CRESTOR®) 5-40mg


- Rosuvastatin is available in 5mg-40mg dose range. The recommended start dose of rosuvastatin is 5 or 10mg2


- The majority of patients achieve their LDL-cholesterol goal with rosuvastatin 10mg3-4


- If necessary, dose adjustment to rosuvastatin 20mg can be made. Patients with severe hypercholesterolemia and at high cardiovascular risk who do not achieve their LDL-cholesterol goal with rosuvastatin 20mg may be titrated to the maximum dose of rosuvastatin 40mg2


- Specialist supervision is recommended when the 40mg dose is initiated2


- Rosuvastatin 20mg is the maximum dose to be used with concomitant fibrate usage; in patients with predisposing factors for developing myopathy/rhabdomyolysis; and in patients of Asian origin2


- The 40 mg dose is the highest registered dose of rosuvastatin2. Rosuvastatin should be used according to the prescribing information, which contains recommendations for initiating and titrating therapy according to the individual patient profile


References:


1. Kassianos et al. An observational study of the effectiveness of rosuvastatin in patients with diabetes in general practice across the united kingdom. Poster presented at ISPOR 10th Annual Congress, 19-23/10/07


2. Crestor SmPC medicines


3. Schuster H, Barter PJ, Stender S, et al. Effects of switching statins on achievement of lipid goals: measuring effective reductions in cholesterol using rosuvastatin therapy (MERCURY I) study. American Heart Journal 2004; 147: 705-712


4. Middleton A et al. Achieving lipid goals in real life: the DISCOVERY-UK study. The British Journal of Cardiology 2006;13:72-76


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