Use of high-intensity statin therapy with simvastatin 80 mg and atorvastatin 80 mg in primary care.

AIMS: Cardiovascular disease (CVD) is the most common cause of death worldwide. Pharmaceutical risk reduction with high-intensity statin therapy is advisable for high-risk patients. Clinicians face a conflict between prescribing for cost (simvastatin 80 mg) or for efficacy (atorvastatin 80 mg). The aim of this audit was to examine the use, efficacy and tolerability of high intensity statin treatment (simvastatin 80 mg; atorvastatin 80 mg) in primary care. METHODOLOGY: Electronic medical records were examined from two general practitioners' surgeries. Analyses involved Mann-Whitney U and χ(2) tests. RESULTS: A total of 116 patients had taken simvastatin 80 mg or atorvastatin 80 mg. Patients were similar between treatment groups: mostly men (62.9%), over 60 years old (68.1%), non-smokers (81.0%) taking statins for secondary prevention (56.9%). More patients on simvastatin withdrew from treatment as a result of inefficacy (49.3% vs. 23.2%, p=0.025) compared with the atorvastatin group. Furthermore, patients on simvastatin were more likely to be failing conventional targets of lipid control, compared with patients on atorvastatin 80 mg (43.5% vs. 21.3%, p=0.006). Tolerability was similar between the two groups. DISCUSSION: UK guidelines recommend simvastatin 80 mg as an economic choice, despite scant evidence at this dose and recent safety concerns. Conversely, robust evidence exists for atorvastatin 80 mg. Head-to-head clinical trials or clinical studies comparing these agents are lacking. The present study suggests that atorvastatin 80 mg compares favourably to simvastatin in terms of efficacy and has a similar tolerability profile. CONCLUSION: This retrospective observational study suggests that despite national guidelines, atorvastatin 80 mg is used in clinical practice and is more effective and at least as well tolerated as simvastatin 80 mg.

Evaluation of the clinical outcomes of switching patients from atorvastatin to simvastatin and losartan to candesartan in a primary care setting: 2 years on.

AIMS: This short report was designed to provide 2-year follow-up data from a previous study carried out in a primary care practice in the UK to assess the clinical and practical implications of switching to generic drugs. METHODS: All patients previously switched from atorvastatin to simvastatin or losartan to candesartan were reviewed retrospectively 2 years after the switch. Total serum cholesterol and clinic blood pressure readings were used along with records of cardiovascular events occuring during the 2 year period to assess the clinical impact of the switch. RESULTS: Of the 69 patients switched from atorvastatin to simvastatin between March and September 2005, 65 are still registered at the practice. Of these, 61 (94%) are still on simvastatin and 58 (89%) on the same dose. There was no significant change in mean total cholesterol over this 2 year period [between 4.04 +/- 0.52 mmol/l prior to the switch and 3.90 +/- 0.63 mmol/l 2 years after the switch (p = 0.06)]. Of the 108 patients switched from losartan to candesartan, 94 are still registered at the practice and taking an angiotensin receptor blocker (ARB), 92 of these (98%) are still on candesartan and there was a significant reduction in blood pressure 2 years post-switch [between 138/79 +/- 12.9/6.6 prior to the switch and 131/77 +/- 13.1/7.6 mmHg 2 years after the switch (p<<0.05)]. No adverse events attributable to the switch were reported in either group. CONCLUSION: This small study provides evidence that switching drugs in primary care can be cost effective and safe in the medium term, if care is taken with selection of patients and there is structured follow-up in place.

Evaluation of the cost savings and clinical outcomes of switching patients from atorvastatin to simvastatin and losartan to candesartan in a Primary Care setting.

This study was carried out in a Primary Care practice in the UK to assess the clinical and practical implications, cost savings and patients' perspective of switching to generic drugs. In the 70 patients switched from atorvastatin to simvastatin there was no significant change in mean total cholesterol 4 months after the switch (4.07 +/- 0.55 mmol/L prior to the switch and 4.10 +/- 0.73 mmol/L post-switch) and only one patient switched back because of side effects. One hundred and fifteen patients were switched from losartan to candesartan. Seven switched back but in those that remained on candesartan there was a small, significant (p = 0.0006), reduction in blood pressure after the switch (138.9/78.7 +/- 13.2/7.0 to 136.3/76.1 +/- 14.7/8.4 mmHg). No adverse events attributable to the switch were reported in either group and the net annualised savings for the year 2005-2006 were 12,715.58 pounds for the statin and 13,374.40 pounds for the antihypertensive switch, respectively.