Harley Carolyn R, Gandhi Sanjay K, Heien Herbert, McDonough Ken, Nelson Stephanie P
i3 Innovus, Health Economics & Outcomes Research, 12125 Technology Drive, Eden Prairie, MN 55344, USA.
Expert Opin Pharmacother. 2008 Apr;9(5):669-76. doi: 10.1517/14656566.9.5.669.
To compare change in low-density lipoprotein cholesterol (LDL-C) levels and National Cholesterol Education Program (NCEP) Adult Treatment Panel III LDL-C goal attainment in diabetic patients treated with rosuvastatin versus other statins in a large, managed care health plan.
This retrospective cohort analysis used medical and pharmacy claims linked to laboratory results from a commercial/MedicareAdvantage health plan. Study participants were >or= 18 years of age, had a diagnosis of diabetes, were newly treated with statins from 8/1/03 to 2/28/05, and were considered at high risk for cardiovascular events as defined by NCEP guidelines. Subjects were continuously enrolled for 12 months pre-index and >or= 30 days post-index, with variable follow-up until therapy discontinuation or end of health plan eligibility.
Change in LDL-C from baseline, and attainment of NCEP LDL-C goal among patients not at goal before starting therapy.
A total of 3337 adult patients with diabetes were identified with new use of statin therapy during the identification period. A total of 9% (n = 301) started on rosuvastatin, 49.4% (n = 1,649) on atorvastatin, 20.7% (n = 690) on simvastatin, 7.0% (n = 234) on pravastatin, 11.7% (n = 391) on lovastatin and 2.2% (n = 72) on fluvastatin. After controlling for covariates, rosuvastatin patients experienced a significantly greater decrease in LDL-C from baseline (38.7%) than patients taking atorvastatin (34.2%) (p = 0.05), simvastatin (31.5%), pravastatin (24.2%), fluvastatin (26.3%) or lovastatin (24.9%) (p < 0.0001). Rosuvastatin users were significantly more likely to attain LDL-C goal than those taking the other statins (odds ratio: 0.44, 0.28, 0.14, 0.14, 0.19, respectively; p < 0.001). Predicted percent attaining goal was significantly greater for those taking rosuvastatin (87.3%) than for those taking atorvastatin (76.9%), simvastatin (68.7%), pravastatin (55.0%), lovastatin (55.3%) or fluvastatin (61.3%) (p < 0.001).
For diabetic patients, rosuvastatin is more effective at reducing LDL-C levels and attaining NCEP ATP III LDL-C goal than other statins in real-world clinical practice.
在一个大型管理式医疗保健计划中，比较接受瑞舒伐他汀治疗的糖尿病患者与接受其他他汀类药物治疗的患者的低密度脂蛋白胆固醇（LDL-C）水平变化以及达到美国国家胆固醇教育计划（NCEP）成人治疗小组第三次报告（ATP III）LDL-C目标的情况。
这项回顾性队列分析使用了与来自商业/医疗保险优势健康计划的实验室结果相关联的医疗和药房理赔数据。研究参与者年龄≥18岁，患有糖尿病，在2003年8月1日至2005年2月28日期间开始新的他汀类药物治疗，并且根据NCEP指南被认为有心血管事件的高风险。受试者在索引前连续入组12个月，索引后≥30天，随访时间不等，直至治疗中断或健康计划资格结束。
LDL-C相对于基线的变化，以及开始治疗前未达到目标的患者中达到NCEP LDL-C目标的情况。
在识别期间共识别出3337例开始新使用他汀类药物治疗的成年糖尿病患者。共有9%（n = 301）开始使用瑞舒伐他汀，49.4%（n = 1649）使用阿托伐他汀，20.7%（n = 690）使用辛伐他汀，7.0%（n = 234）使用普伐他汀，11.7%（n = 391）使用洛伐他汀，2.2%（n = 72）使用氟伐他汀。在控制协变量后，瑞舒伐他汀治疗的患者LDL-C从基线的下降幅度（38.7%）显著大于服用阿托伐他汀（34.2%）（p = 0.05）、辛伐他汀（31.5%）、普伐他汀（24.2%）、氟伐他汀（26.3%）或洛伐他汀（24.9%）的患者（p < 0.0001）。与服用其他他汀类药物的患者相比，瑞舒伐他汀使用者达到LDL-C目标的可能性显著更高（优势比分别为0.44、0.28、0.14、0.14、0.19；p < 0.001）。服用瑞舒伐他汀的患者达到目标的预测百分比（87.3%）显著高于服用阿托伐他汀（76.9%）、辛伐他汀（68.7%）、普伐他汀（55.0%）、洛伐他汀（55.3%）或氟伐他汀（61.3%）的患者（p < 0.001）。
在实际临床实践中，对于糖尿病患者，瑞舒伐他汀在降低LDL-C水平和达到NCEP ATP III LDL-C目标方面比其他他汀类药物更有效。
