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Study Confirms Benefit Of New Statin, Crestor (Rosuvastatin), In 'Real Life Setting

LONDON, ENGLAND -- October 8, 2003 -- A new British study of over 80,000 CHD patients and 220 GPs confirms the ongoing failure of older statins to get patients to cholesterol targets set out in the National Service Framework (NSF) for coronary heart disease (CHD).1 The results of the Performance for Life study, which was conducted by Dr Adrian Brady, consultant cardiologist at Glasgow Royal Infirmary, were announced at the weekend at the annual meeting of the Primary Care Cardiovascular Society (PCCS) in Dublin. The study revealed that only 48 per cent of CHD patients who qualified for the analysis* achieved these cholesterol targets leaving more than half exposed to the risk of further cardiovascular events.2 Furthermore, many patients never get beyond the starting dose of their statin. The Performance for Life study was conducted before a new high performance statin, CrestorŽ (rosuvastatin) became available.

The results of a separate clinical study, DISCOVERY, which was carried out in the setting of UK primary care, reflecting 'real life' practice, were also presented at the PCCS meeting. They showed that substantially more patients (more than three quarters) achieved the recommended NSF for CHD cholesterol targets1 when treated with rosuvastatin compared to other statins. Of patients receiving rosuvastatin 10mg, 75.1 per cent had their total cholesterol lowered to below 5mmol/l and by 25 per cent, as recommended in the NSF for CHD. Comparatively, only 59 per cent of patients receiving atorvastatin 10mg and only 50.7 per cent of those receiving simvastatin 20mg reached the target reduction of 25 per cent.3 (See notes to editor for further details on DISCOVERY).

Dr Ahmet Fuat, GP and DISCOVERY investigator noted: "Guidelines are getting tougher, and if NSF targets follow the new European cholesterol targets, which recommend that total cholesterol levels should be below 4.5mmol/l and LDL cholesterol below 2.5mmol/l, UK GPs will come under even greater pressure. The option to prescribe high performance statins will be essential if we are to tackle CHD efficiently and effectively in Britain."

The Performance For Life Study
The Performance for Life study, is a two-part study designed to assess GPs' perceptions of how they are managing their patients' cholesterol, and the real-life performance of statin treatment in general practice throughout the UK. The study analysed the feedback of 220 GP questionnaires and the records of over 80,000 patients with established CHD**, 14,424 of whom were prescribed statins available at the time – atorvastatin, fluvastatin, pravastatin or simvastatin.

A total of 220 completed GP questionnaires revealed that in evaluating their own performance, GPs perceive that 80% of patients achieve cholesterol targets. A key finding from the analysis of patient records following statin treatment, however, shows that in reality this is far from the case.

Additionally, over two thirds of GPs (67 per cent) felt that a great deal of time is taken up reviewing treatments of high cholesterol patients, and more than half (52 per cent) admitted they did not have time to identify and review patients potentially at risk of a cardiovascular event.4 Nearly all GPs stated that the resulting direct costs to their practice and supporting laboratories were substantial. In addition, over two thirds expressed concern about extra drug costs incurred when increasing doses and changing statin therapy.4

More than half (57 per cent) of GPs surveyed expressed concern about the potential side effects when higher doses of older statins are required to reduce cholesterol to within recommended NSF for CHD cholesterol targets.1,4

The reality for patients was revealed following the analysis of over 14,000 British patient records. Less than two-thirds of patients had their cholesterol levels rechecked within three months of starting statin treatment,2 leaving patients open to the potential risks of sub-optimal cholesterol management. Of the patients on older statins that had their cholesterol levels checked, less than half (48 per cent) achieved the recommended 25 per cent reduction in cholesterol specified in the NSF for CHD1 and one in three patients had not even succeeded in reducing their total cholesterol to the guideline target of below 5 mmol/l.2

However, even when these adjustments took place, only 56 per cent finally achieved a cholesterol reduction of 25 per cent.2 Diabetic patients who failed initial statin therapy were even less successful.5 Fewer than 10 per cent eventually reached their target cholesterol reduction despite a change in statin dose or a switch to an alternative statin.5

Dr Adrian Brady concluded, "To improve this country's poor performance on CHD management, and put us on a par with our European and American counterparts, we need to better manage our patients on older statins, or quickly start taking advantage of new treatments such as rosuvastatin."

Crestor is a Trade Mark of the AstraZeneca group of companies and is made in the UK.

* IMS Research Database analysis of records from 80,096 patients registered with CHD, of whom 14,424 were on statins and 8,434 qualified for analysis.

** Patient records analysed in the Performance for Life study were those of patients registered on the IMS database.

References
1. Department of Health. National Service Framework for Coronary Heart Disease www.doh.gov.uk/nsf/coronarych2.htm. March 2000
2. Brady AJB, Norrie J and Ford I. Failure to achieve cholesterol targets with statins in UK general practice - the Performance for Life study. Abstract presented at PCCS, October 2003
3. Middleton A, Fuat A, Strang C on behalf of UK DISCOVERY investigators. Treating patients to lipid targets: first results of the DISCOVERY study. (supply publication details eg, abstract in PCCS book.)
4. Brady AJB, Norrie J and Ford I. Failure to achieve cholesterol targets with statins in UK General Practice – the Performance for Life study. Poster presented at PCCS, October 2003.
5. Brady AJB, Norrie J and Ford I. Failure to achieve cholesterol targets with statins in UK diabetics - the Performance for Life Diabetes substudy. Abstract presented at PCCS, October 2003.


SOURCE: Burson-Marsteller

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