Liječnički vjesnik (Apr 2021)

Adherence and prescription of statin therapy in primary prevention in primary care unit

  • Juraj Jug,
  • Valentina Juraga,
  • Ivor Jeavić

DOI
https://doi.org/10.26800/LV-143-3-4-2
Journal volume & issue
Vol. 143, no. 3-4
pp. 90 – 94

Abstract

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Aim: Apart from underdiagnosed familial hypercholesterolemia, idiopathic hypercholesterolemia in Croatian population is one of the most common and ignored problems in everyday clinical practice. This study aimed to present the situation of statin use in primary prevention in the average Croatian primary care unit, and to reveal the main reasons why patients do not take statins in primary cardiovascular prevention. Materials & Methods: We analyzed lab test results (LDL cholesterol and non-HDL cholesterol, triglyceride, and creatinine levels in serum) of 1608 patients in one primary care unit from the Health Center Zagreb – West during June 2019. If a patient took statin therapy his LDL cholesterol was calculated by multiplying with the corresponding correction factor. We included all patients whose LDL cholesterol , corrected or measured, exceeded 5mmol/L. Kidney function was calculated by the CKD-EPI formula. All patients with any liver and kidney disease were excluded, as well as uncontrolled diabetic patients. Patients with previous myocardial infarction and/or cerebrovascular insult were also excluded. Results: Out of 1608 patients, 40 (26 female, 14 male, total 2.5%) presented with LDL-cholesterol above 5 mmol/L (max. 10.2 mmol/L). There were no gender differences. Thirty-eight patients (95%) were hypertensive, and eight (20%) had controlled diabetes mellitus type 2. Despite LDL cholesterol levels, only ten patients had prescribed statin therapy (25%). The levels of non-HDL cholesterol in these patients showed a range from 5.3 to 12.1 mmol/L. In 13 patients we found evidence of mixed hyperlipidemia. The age of patients varied from 52 to 89 years. Kidney function deteriorated with aging (Spearman r=–0.71, p<0.01), but LDL cholesterol and non-HDL cholesterol values didn’t depend on those changes. Thirteen analyzed patients were over 70 years old. Conclusion: In primary prevention hypercholesterolemia, as one of the independent risk factors for cardiovascular disease development, is still an underestimated problem. Despite the obvious evidence and very high serum cholesterol levels, doctors’ disbelief in statin efficacy and patients’ low compliance lead to disappointing results in prescribing lipid-lowering drugs in primary prevention.

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