The STatin Adverse Treatment Experience Survey: Experience of patients reporting side effects of statin therapy.

BACKGROUND: It is important to understand patients' experiences of statin-associated adverse effects to potentially identify those at risk for stopping treatment. OBJECTIVE: The goal of the STatin Adverse Treatment Experience survey was to describe patients' experiences after reporting ≥1 recent statin-associated adverse event and identify opportunities to improve adherence and outcomes. METHODS: The survey was developed in 3 stages: qualitative item development, pilot evaluation of initial item performance, and quantitative evaluation using a large commercial sample. Respondents with self-reported high cholesterol who had taken a statin in the past 2 years and experienced ≥1 statin-associated symptom in the past 6 months were included (N = 1500). RESULTS: Mean age was 58 years, 40.3% were men, and 43.2% had tried ≥2 statins. Many had clinical comorbidities associated with increased risk for cardiovascular disease (atherosclerotic cardiovascular disease, 22.5%; diabetes, 25.8%; hypertension, 56.0%). The most important patient-reported reasons for continuing current statin therapy (n = 1168; 77.9%) were avoiding a heart attack or stroke, lowering cholesterol, and doctor recommendation. Being bothered by and not being able to tolerate side effects were the main reasons respondents discontinued statins (n = 332; 22.1%). Respondents who discontinued statins reported significantly higher mean Symptom Severity (10.6 vs 8.7, P < .001) and Impact Severity scores (11.8 vs 9.8, P < .001) compared with those who continued. CONCLUSION: The STatin Adverse Treatment Experience survey highlights the importance of patients' adverse experiences with statins and how symptom and impact scores affect decisions to continue or discontinue therapy. These data provide a foundation to increase providers' awareness of statin tolerability from the patient's perspective and encourage benefit-risk discussions.

National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2.

An Expert Panel convened by the National Lipid Association previously developed a consensus set of recommendations for the patient-centered management of dyslipidemia in clinical medicine (part 1). These were guided by the principle that reducing elevated levels of atherogenic cholesterol (non-high-density lipoprotein cholesterol and low-density lipoprotein cholesterol) reduces the risk for atherosclerotic cardiovascular disease. This document represents a continuation of the National Lipid Association recommendations developed by a diverse panel of experts who examined the evidence base and provided recommendations regarding the following topics: (1) lifestyle therapies; (2) groups with special considerations, including children and adolescents, women, older patients, certain ethnic and racial groups, patients infected with human immunodeficiency virus, patients with rheumatoid arthritis, and patients with residual risk despite statin and lifestyle therapies; and (3) strategies to improve patient outcomes by increasing adherence and using team-based collaborative care.

JCL Roundtable: Gender differences in risk reduction with lifestyle changes.

The first efforts to uncover the causes of cardiovascular disease focused on the behavioral, now called lifestyle habits of populations. Diet, exercise, and smoking were recognized as important issues with strong relationships in community-based observational studies such as the Seven Countries study, the Framingham Heart Study, and the Western Electric Study in Chicago. The first meaningful intervention in the United States was the dietary recommendations made by the American Heart Association in 1963 and the Surgeon General's Report on Smoking and Health in 1964. The American public listened and a very large change occurred in food consumption data and cigarette smoking over the next decade. These changes were mainly focused on men because the incidence of myocardial infarction was much higher in middle aged and older men than women. As smoking prevalence has decreased in men and increased in women and the population has aged, the differences in major vascular events have virtually disappeared. Women still enjoy a longer period of low rates but eventually the incidence rates approach those of men. As we constantly attempt to demonstrate ways of reducing risk by improved lifestyle it behooves us to re-evaluate the potential differences in gender response and adjust our expectations accordingly as clinicians.

Obesity, adiposity, and dyslipidemia: a consensus statement from the National Lipid Association.

The term "fat" may refer to lipids as well as the cells and tissue that store lipid (ie, adipocytes and adipose tissue). "Lipid" is derived from "lipos," which refers to animal fat or vegetable oil. Adiposity refers to body fat and is derived from "adipo," referring to fat. Adipocytes and adipose tissue store the greatest amount of body lipids, including triglycerides and free cholesterol. Adipocytes and adipose tissue are active from an endocrine and immune standpoint. Adipocyte hypertrophy and excessive adipose tissue accumulation can promote pathogenic adipocyte and adipose tissue effects (adiposopathy), resulting in abnormal levels of circulating lipids, with dyslipidemia being a major atherosclerotic coronary heart disease risk factor. It is therefore incumbent upon lipidologists to be among the most knowledgeable in the understanding of the relationship between excessive body fat and dyslipidemia. On September 16, 2012, the National Lipid Association held a Consensus Conference with the goal of better defining the effect of adiposity on lipoproteins, how the pathos of excessive body fat (adiposopathy) contributes to dyslipidemia, and how therapies such as appropriate nutrition, increased physical activity, weight-management drugs, and bariatric surgery might be expected to impact dyslipidemia. It is hoped that the information derived from these proceedings will promote a greater appreciation among clinicians of the impact of excess adiposity and its treatment on dyslipidemia and prompt more research on the effects of interventions for improving dyslipidemia and reducing cardiovascular disease risk in overweight and obese patients.

In search of self-awareness: results of the National Lipid Association 2010 Lipid Pulse membership survey.

BACKGROUND: In 2010 a survey of the National Lipid Association (NLA) membership was developed and launched with the objective of exploring the demographics, practice patterns, and educational needs of the health professionals in our organization involved in the practice of clinical lipidology. OBJECTIVES: To report the results of this survey and use this information to enable the organization to better serve the needs of our membership. METHODS: A 30-question survey was administered to the NLA membership before and shortly after the Annual Scientific Sessions in May, 2010. Demographic information, test ordering patterns, educational needs and resources, and technology awareness of 640 valid respondents was assessed. RESULTS: The respondents represent a balanced mix of practitioners in rural and metropolitan population centers throughout the United States. Physicians represent 67%, nurse practitioners and physician assistants 16%, and pharmacists 8% of the respondents. Among physicians, 50% are internal medicine or family medicine specialists, 32% cardiologists, and 11% endocrinologists. Most working in lipid clinics reported that their clinic was financially solvent. The respondents believed that adjunctive lipoprotein testing was clinically useful in risk prediction. The greatest educational needs included statin intolerance; strategies for improving compliance; metabolic syndrome; and lipoprotein particle and apolipoprotein B concentration. The most important sources of lipid information were the Journal of Clinical Lipidology and the NLA Annual Scientific Sessions. CONCLUSIONS: The survey provided valuable information that may be used to better serve the practice and educational needs of the membership of the NLA.