Replacing one lipid-lowering drug by the other: the pros and cons with prolonged ambulatory monitoring

Abstract

Aim. Long term administration of lipid-lowering drugs is one of the important and key moments in the outpatient management. This paper analyzes the results of lipid-lowering therapy and replacement of lipid-lowering drugs by another in an outpatient practice, as well as the effectiveness of this replacement in patients with cardiovascular disease. The aim was to analyze the dynamics of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), highdensity lipoprotein cholesterol (HDL-C), triglycerides (TG), when changing lipid-lowering therapy in a real outpatient practice.
Materials and methods. The study included 163 patients with high/very high risk of cardiovascular events (on a scale SCORE) (HRCVE group) and 173 patients with coronary artery disease (CAD group). The study was open. All patients were taking rosuvastatin as a lipid-lowering drug during the first year of observation, which was issued free of charge. After 1 year of treatment rosuvastatin was replaced by atorvastatin, which was given for free by local doctors. Some of the patients did not want to change drug and remained on rosuvastatin therapy “at their own expense”. The patients also received other medical treatment according to indications (beta-blockers, angiotensin-converting-enzyme inhibitors, calcium channel blockers, diuretics and nitrates). Instrumental and laboratory tests (clinical examination, electrocardiography, blood chemistry) were performed at baseline, after 12 and 24 months of statin therapy.
Results. Lipid-lowering therapy for 24 months was well tolerated by patients. A significant reduction in TC, TG, LDL-C and an increase in HDL-C were observed in two groups of patients in a year. A statistically significant adherence increase to the therapy in both groups and improve of patients’ life quality were also found. One year after rosuvastatin was changed for atorvastatin there was a statistically significant increase in the level of TC (p=0.004) and LDL-C (p=0.002) in CAD group of patients. In the group with high/very high risk of the same pattern an increase of TC and LDL-С (p=0.0007 and p=0.00008, respectively) was observed. TG and HDL-C were not significantly changed. In the rosuvastatin group the levels of TC, TG, HDL-C did not change, however, a slight, but statistically significant increase in LDL-C levels in both groups (p=0.0009 and p=0.04 respectively, in the
group of HRCVE and the group of CAD) was found. No statistically significant changes in terms of aspartate aminotransferase, alanine aminotransferase, creatine kinase in both groups were observed.
Conclusion. The results showed high efficacy and good tolerability of long-term lipid-lowering therapy in both patients with CAD and with high/very high risk of CAD in the outpatient setting. When a high efficacy of one lipidlowering drug is achieved the change for other drug in an outpatient setting may lead to a decrease of treatment efficacy