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HOME > Cardiovasc Prev Pharmacother > Volume 2(3); 2020 > Article
Original Article Changes in Target Achievement Rates after Statin Prescription Changes at a Single University Hospital
Seon Choe, MS1orcid, Jiwon Shinn, BS2orcid, Hun-Sung Kim, MD, PhD2,3,*orcid, Ju Han Kim, MD, PhD1,*orcid
Cardiovascular Prevention and Pharmacotherapy 2020;2(3):103-111.
DOI: https://doi.org/10.36011/cpp.2020.2.e14
Published online: July 31, 2020
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1Division of Biomedical Informatics, Systems Biomedical Informatics Research Center, Seoul National University College of Medicine, Seoul, Korea

2Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea

3Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Hun-Sung Kim, MD, PhD Department of Medical Informatics, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. E-mail: 01cadiz@hanmail.net
Correspondence to Ju Han Kim, MD, PhD Division of Biomedical Informatics, Systems Biomedical Informatics Research Center, Seoul National University College of Medicine 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. E-mail: juhan@snu.ac.kr
*Ju Han Kim and Hun-Sung Kim are cocorresponding author, with each contributing equally to this manuscript.
• Received: June 12, 2020   • Accepted: July 27, 2020

Copyright © 2020 Korean Society of Cardiovascular Disease Prevention; International Society of Cardiovascular Pharmacotherapy, Korea Chapter.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • Background
    We investigated the changes in low-density lipoprotein cholesterol (LDL-C) target achievement rates (<70 and <100 mg/dL) when the prescription changed from various statins to Lipilou®, a generic formulation of atorvastatin.
  • Methods
    This was a retrospective cohort study of patients who had been prescribed Lipilou® for more than 3 months at Seoul National University Hospital from 2012 to 2018. For patients who were treated with a previous statin before the prescription of Lipilou®, changes in target achievement rates of LDL-C less than 70 and less than 100 mg/dL were confirmed 3–6 months after the prescription of Lipilou®.
  • Results
    Among the 683 enrolled patients, when their prescription was changed to Lipilou®, the target achievement rate of LDL-C significantly increased for LDL-C less than 70 mg/dL (from 22.1% to 66.2%, p<0.001) and less than 100 mg/dL (from 26.8% to 75.3%, p<0.001). In particular, when a moderate-low potency statin was changed to Lipilou® (10 mg), the target achievement rates for LDL-C less than 70 mg/dL (from 28.9% to 66.7%, p<0.001) and less than 100 mg/dL (from 42.2% to 86.7%, p<0.001) significantly increased. The change from a moderate-high potency statin to Lipilou® (20 mg) showed an increased target achievement rates for LDL-C <70 mg/dL (from 33.3% to 80.0%, p=0.008) and 100 mg/dL (from 40.0% to 73.3%, p<0.025).
  • Conclusions
    We cannot simply conclude that Lipilou® is superior to other statins. However, when the target LDL-C was not reached with previous statin treatments, a high target achievement rate could be achieved by changing the prescription to Lipilou®. Physicians should always consider aggressive statin prescription changes for high target achievement rates.
Cardiovascular disease (CVD) is one of the leading causes of death worldwide and has resulted in 17 million deaths in 2008, accounting for 30% of all deaths.1) With this current trend, it is estimated that the number of deaths from CVD will rise from 17.5 million in 2012 to 22.2 million by 2030.2)3) Dyslipidemia is a major risk factor for the development of CVD,4)5) and has been regarded as one of the reasons for the steady increase in CVD in Korea.6) Low-density lipoprotein cholesterol (LDL-C) is the primary target in the management of dyslipidemia,7) and lipid-lowering therapies for secondary prevention of CVD have been reported to reduce the risk of recurrent cardiovascular events, morbidity, and disability.1)5)
Statins, also known as 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, are recommended as the primary treatment for dyslipidemia8) and are the most effective drugs to prevent CVD.9)10) Various guidelines recommend that the LDL-C target value be set lower depending on the risk factors and presence of accompanying diseases; however, even with the 2016 European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines,11) 2018 American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) guidelines,12) and 2019 ESC guidelines,13) the achievement rates of LDL-C target levels are still low. In particular, the target achievement rate of LDL-C is too low in Asians; approximately 50% of Asian patients with dyslipidemia and 70% of high-risk patients with CVD do not achieve their target LDL-C levels.14) Despite the need to actively attempt for statin changes in case the fall of LDL-C control, it is not applied in clinical practice.15)
Currently, atorvastatin is prescribed for most treatments of dyslipidemia in Korea.16)17) Since the expiration of the original patent for atorvastatin in 2008, many generic formulations of atorvastatin have been released to date, and these formulations are not inferior in terms of their effectiveness or tolerability compared to the original atorvastatin. The purpose of this study was to evaluate the efficacy and safety of Lipilou® (Chong Kun Dang Pharmacy Corp., Seoul, Korea), a generic formulation of atorvastatin. This study is an electronic medical record (EMR)-based retrospective cohort study to evaluate the changes in LDL-C target achievement rates when various types of statins or the same type of atorvastatin are changed to Lipilou®.
Study population and design
The subjects consisted of patients who have been prescribed the generic atorvastatin drug, Lipilou® (10, 20, and 40 mg), at Seoul National University Hospital from March 1, 2012 to December 31, 2018. Among patients over 18 years old, those who had been prescribed the drug for more than 3 months after visiting the hospital at least twice and had recorded LDL-C measurements were enrolled. Patients under the age of 18 years or who were prescribed the drug for less than 3 months were excluded from the study.
Study design
The date of the first prescription was defined as the index date (baseline) of the subjects, and the follow-up 3–6 months after the index date was defined as visit 1. Height, weight, and blood test data that were measured within the index date and visit 1 were extracted, including blood urea nitrogen (BUN), creatinine (Cr), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol (TC), triglyceride, LDL-C, and high-density lipoprotein cholesterol. If there were more than two blood tests within this period, the measurement taken closer to 90 days from the index date was selected.
Other types of statins that were administered before the index date were also determined. After shifting treatment from other types of statins to Lipilou®, the therapeutic thresholds of LDL-C less than 70 mg/dL and less than 100 mg/dL were identified. Previous statin treatments were divided into four types according to their intensity: high potency such as rosuvastatin (20 mg) and atorvastatin (40 mg); moderate-high potency such as pitavastatin (4 mg), simvastatin (40 mg), rovastatin (10 mg), and atorvastatin (20 mg); moderate-low potency such as fluvastatin (80 mg), pitavastatin (2 mg), pravastatin (40 mg), simvastatin (20 mg), rovastatin (5 mg), and atorvastatin (10 mg); and low potency such as fluvastatin (40 mg) and pravastatin (10 or 20 mg).
Protection of privacy
This study is an EMR-based retrospective cohort study, wherein all data was extracted after anonymization and stored as an encrypted file. This study was approved by the institutional review board of the Seoul National University Hospital Institutional Review Board. Owing to the anonymity of the data and the retrospective nature of the study, informed consent was not required.
Statistical analysis
Data was expressed as means ± standard deviations for continuous variables, and numbers including percentages for categorical variables. The comparison of LDL-C as a normal range between the baseline time up to 3–6 months was performed using McNemar's test by considering the intensity and dosage of the statin. The association between statin prescription and lipid profiles or clinical variables was assessed using a paired t-test. All statistical analyses were performed using SAS version 9.4 (SAS Institute, Inc., Cary, NC, USA), and p-values less 0.05 were considered statistically significant.
A total of 3,991 patients who have been prescribed generic atorvastatin at least once at the Seoul National University Hospital were identified. Among them, 714 patients with a short-term (less than 60 days) prescriptions, 1,449 patients without laboratory test results, 619 patients without baseline LDL-C results, and 526 patients without follow-up LDL-C results were excluded. After these exclusions, 683 patients were included in this study (Figure 1).
The patients included in this study had an average age of 63.4±11.3 years and an average BMI of 24.6±3.4 kg/m2 (Table 1). Lipilou® at a dose of 10 mg was most frequently prescribed (71.7%, 490/683 patients), followed by dose of 20 mg (27.2%, 186/683 patients) and 40 mg (1.0%, 7/683 patients). When examining 96 statins used before the prescription, the most frequent change was from a moderate-low potency statin to Lipilou® (69.8%, 67/96 patients), followed by a moderately potent statin (24.0%, 23/96 patients), a high potency statin (5.2%, 5/96 patients), and a low potency statin (1.0%, 1/96 patients). For 587 patients (85.9%, 587/683 patients), the previous statin prescription could not be confirmed.
When the statin prescription was changed to Lipilou®, the achievement of therapeutic thresholds of LDL-C less than 70 mg/dL (from 22.1% to 66.2%, p<0.001) and less than 100 mg/dL (from 26.8% to 75.3%, p<0.001) increased significantly (Table 2). After a prescription change from a moderate-low potency statin to Lipilou®, the achievement of therapeutic thresholds of LDL-C were found to increased significantly. In particular, in an equivalent potency group, wherein a moderate-low potency statin was changed to Lipilou® (10 mg), the achievement rates for LDL-C less than 70 mg/dL (from 28.9% to 66.7%, p<0.001) and less than 100 mg/dL (from 42.2% to 86.7%, p<0.001) were significantly increased. On the other hand, the change from a moderately high potency statin to Lipilou® (20 mg) resulted in increased achievement rates of therapeutic thresholds of LDL-C less than 70 mg/dL (from 33.3% to 80.0%, p=0.008) and 100 mg/dL (from 40.0% to 73.3%, p=0.025). When the potency was lowered from a moderate to high potency statin to Lipilou® (20 mg), the achievement rates for therapeutic thresholds of LDL-C less than 70 mg (from 50.0% to 75.0%, p=0.317) and less than 100 mg (from 50.0% to 100.0%) increased, but were not statistically significant.
Table 3 shows the results of prescription changes from the same atorvastatin family to Lipilou®. All 66 cases where the atorvastatin prescription was changed to Lipilou® showed significantly increased achievements of therapeutic thresholds of LDL-C less than 70 mg/dL (from 33.3% to 77.3%, p<0.001) and less than 100 mg/dL (from 42.4% to 80.3%, p<0.001) compared to baseline (Table 3). When a moderate-low potency statin prescription was changed to Lipilou® (10 mg), the achievement rates of therapeutic thresholds of LDL-C less than 70 mg/dL (from 35.3% to 73.5%, p<0.001) and less than 100 mg/dL (from 47.1% to 88.2%, p<0.001) significantly increased. When a moderate-high potency statin prescription was changed to Lipilou® (20 mg), the achievement rates for LDL-C therapeutic thresholds less than 70 mg/dL (from 33.3% to 100.0%) and less than 100 mg/dL (from 44.4% to 77.8%, p=0.025) increased. When the prescription was changed from a moderate-to-high potency statin to Lipilou® (20 mg), there were increased achievement rates for therapeutic thresholds of LDL-C less than 70 mg (from 50.0% to 75.0%, p=0.317) and less than 100 mg (from 50.0% to 100.0%), but no meaningful trends were found.
We also assessed changes in liver and kidney blood test results after the prescription (Table 4), wherein there were no significant differences in the values at baseline compared to 3 months after the prescription change. We found that that 0.2% (1/594 patients) of patients had their AST increased more than 3 times the normal upper limit, while 0.3% (2/678 patients) of patients had their ALT increased more than 3 times the normal upper limit.
Dyslipidemia is a major factor that contributes to CVD in Korea, and a reduction of LDL-C by 1.0 mmol/L has been reported to decrease the number of cases of CVD by 20%.18)19) Nevertheless, the perception and treatment rate of dyslipidemia is low in Asia, with untreated and uncontrolled high-risk patients accounting for 60% and up to 30% of all cases, respectively.14)20)21) In Korea, only 2 of 5 patients have been reported to reach their TC target levels.22) For this reason, medical staff should check the achievement of LDL-C target levels after statin prescription, and changes in either the dosage or type of statin need to be considered for cases that do not reach these target levels.
In this study, data of 683 patients with generic atorvastatin and Lipilou® prescriptions were extracted from 7 years of EMRs at Seoul National University. In patients who have been taking statins and switched their prescription to generic atorvastatin, the target achievement rate of LDL-C increased significantly. In particular, when the prescription was changed from a moderate-low statin to 10 mg of generic atorvastatin or from a moderate-high potency statin to 20 mg of generic atorvastatin, where the drop effect of LDL-C is known to be the same, the achievement rate was significantly increased for both LDL-C targets of less than 70 mg/dL and less than 100 mg/dL. In fact, it is difficult to evaluate the increased target achievement as a single effect of this generic drug because the statin change itself can affect patient compliance. However, if the LDL-C value does not reach the target level, simply changing to the prescription to a generic formulation of atorvastatin can help in significantly reducing LDL-C levels.
In the 2016 ESC/EAS,11) 2018 AACE/ACE,12) and 2019 ESC guidelines,13) the target LDL-C value was set lower. Despite the established guidelines for the target values of LDL-C, treatment gaps that do not reach the target level exist in actual clinical settings, and clinicians should actively focus on reducing these. Among the various ways to achieve this, active statin change is a primary consideration when the goal of the LDL-C is not reached.
Similar results were obtained when the prescription was changed from other generic atorvastatin agents. Even in cases where a statin of equivalent potency was changed to Lipilou®, the target achievement rate of LDL-C tended to increase. In the KoLipilou study of CVD patients in Korea, there was no difference in LDL-C levels between the two groups who were prescribed original atorvastatin and Lipilou®, and there was no significant difference in the incidence of side effects.23) In the LAMP study, a real-world observational study of Lipilou®, the achieved therapeutic thresholds of LDL-C were high (69%–80%), especially in patients taking a moderate-potency statin.24) This demonstrates that the generic formulation of atorvastatin is objectively efficacious and safe, thereby providing supporting evidence for active statin prescription changes.
After the prescription changes to Lipilou®, other laboratory results such as ALT, AST, BUN, creatine, and eGFR levels did not show any statistically significant changes. In particular, the increase in ALT to 3 times more than a normal value was only found in 0.3% of patients. If the AST or ALT level was more than 3 times higher than that of upper normal limit after the statin prescription, it can be considered that the incidence is considerably lower than that known by 0.5–2.0%.25) Even though this study has a short follow-up period of 3–6 months, our results are clinically meaningful because in previous studies, the increase in AST or ALT level due to statins mainly occurs in the first 3 months of treatment.
Since this study is an EMR-based retrospective cohort study of a single institution, it has some limitations.26)27) First, due to the nature of a retrospective cohort study, a large amount of data was missing. In fact, this study was conducted in about 20% of patients who were prescribed Lipilou®. Moreover, it is difficult to ascertain the case history of statin prescriptions from another hospital. If the prescription was not properly written in the medical record, it can be difficult to confirm even if a direct chart review by medical staff is conducted. Because of this, cases were classified as “unknown” if it was uncertain whether other statins were prescribed prior to the Lipilou® prescription. Therefore, the relatively small presence of former statins is also a limitation. However, this study provides real-world evidence based on EMR data; this study reported the achievement rates of therapeutic thresholds of LDL-C in patients taking generic atorvastatin in real-world clinical practice.
The results of this study showed that this generic agent was not inferior to other types of statins or original statins in terms of efficacy and stability. Moreover, if the LDL-C level cannot be reached with the existing statins, an increased achievement of target rate can be expected only by actively switching to Lipilou®. Aggressive prescription changes may also be worth considering. However, it is difficult to conclude from this study whether the specific agent is superior to other types of statins. In order to objectively support the results of this study, prospective large-scale studies will be needed, and we hope that this study can be a basis for these future studies.

Funding

The current study was financially supported by the Chong Kun Dang Pharm (Seoul, Korea), who had no role in data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of Interest

The authors have no financial conflicts of interest.

Author Contributions

Conceptualization: Choe S; Data curation: Kim HS, Kim JH; Formal analysis: Kim HS, Kim JH; Methodology: Choe S; Supervision: Kim HS, Kim JH; Writing - original draft: Choe S; Writing - review & editing: Shinn J.

Figure 1.
Flow chart describing the process of patient enrollment. Among the 3,991 patients who had a prescription history of Lipilou®, 683 patients who met the criteria have been enrolled.
LDL-C = low density lipoprotein cholesterol; SNUH = Seoul National University Hospital.
cpp-2020-2-e14f1.jpg
Table 1.
Baseline characteristics of patients
Variables Values (n=683)
Age (years) 63.4±11.3
Sex
 Male 325 (47.6)
 Female 358 (52.4)
Height (cm) 161.3±9.6
Weight (cm) 64.0±11.8
BMI (kg/m2) 24.6±3.4
Lipilou® dosage
 10 mg 490 (71.7)
 20 mg 186 (27.2)
 40 mg 7 (1.0)
Former statin
 Low potency 1 (0.1)
 Moderate-low potency 67 (9.8)
 Moderate-high potency 23 (3.4)
 High potency 5 (0.7)
 Unknown 587 (85.9)

Categorical variables are reported as frequencies (%), and continuous variables are reported as mean±standard deviation.

BMI = body mass index.

Table 2.
Target achievement rate according to the type of statin previously received
Variables No. LDL-C<70 mg/dL
LDL-C<100 mg/dL
Baseline Visit 1 p value Baseline Visit 1 p value
Total 683 151 (22.1) 452 (66.2) <0.001 183 (26.8) 514 (75.3) <0.001
From low potency statin
 20 mg 1 0 (0.0) 1 (100.0) >0.999 0 (0.0) 1 (100.0) >0.999
From moderate-low potency statin
 10 mg 45 13 (28.9) 30 (66.7) <0.001 19 (42.2) 39 (86.7) <0.001
 20 mg 22 5 (22.7) 15 (68.2) 0.002 9 (40.9) 17 (77.3) 0.005
 Total 67 18 (26.9) 45 (67.2) <0.001 28 (41.8) 56 (83.6) <0.001
From moderate-high potency statin
 10 mg 7 2 (28.6) 4 (57.1) 0.157 2 (28.6) 4 (57.1) 0.157
 20 mg 15 5 (33.3) 12 (80.0) 0.008 6 (40.0) 11 (73.3) 0.025
 40 mg 1 0 (0.0) 0 (0.0) >0.999 0 (0.0) 0 (0.0) >0.999
 Total 23 7 (30.4) 16 (69.6) 0.003 8 (34.8) 15 (65.2) 0.008
From high potency statin
 10 mg 1 0 (0.0) 1 (100.0) >0.999 0 (0.0) 1 (100.0) >0.999
 20 mg 4 2 (50.0) 3 (75.0) 0.317 2 (50.0) 4 (100.0) N/A
 Total 5 2 (40.0) 4 (80.0) 0.157 2 (40.0) 5 (100.0) N/A
From unknown
 10 mg 437 86 (19.7) 281 (64.3) <0.001 99 (22.7) 323 (73.9) <0.001
 20 mg 144 37 (25.7) 103 (71.5) <0.001 45 (31.3) 111 (77.1) <0.001
 40 mg 6 1 (16.7) 2 (33.3) 0.317 1 (16.7) 3 (50.0) 0.157
 Total 587 124 (21.1) 386 (65.8) <0.001 145 (24.7) 437 (74.6) <0.001

Categorical variables are reported as frequencies (%).

LDL-C = low density lipoprotein cholesterol.

Table 3.
Target achievement rate according to the type of atorvastatin previously received
Variables No. LDL-C<70 mg/dL
LDL-C<100 mg/dL
Baseline Visit 1 p value Baseline Visit 1 p value
Total 66 22 (33.3) 51 (77.3) <0.001 28 (42.4) 53 (80.3) <0.001
From moderate-low potency atorvastatin (10 mg)
 10 mg 34 12 (35.3) 25 (73.5) <0.001 16 (47.1) 30 (88.2) <0.001
 20 mg 15 4 (26.7) 12 (80.0) 0.005 5 (33.3) 10 (66.7) 0.005
 Total 49 16 (32.7) 37 (75.5) <0.001 21 (42.9) 40 (81.6) <0.001
From moderate-high potency atorvastatin (20 mg)
 10 mg 4 1 (25.0) 2 (50.0) 0.317 1 (25.0) 2 (50.0) 0.157
 20 mg 9 3 (33.3) 9 (100.0) N/A 4 (44.4) 7 (77.8) 0.025
 Total 13 4 (30.8) 11 (84.6) 0.008 5 (38.5) 9 (69.2) 0.008
From high potency atorvastatin (40 mg)
 20 mg 4 2 (50.0) 3 (75.0) 0.317 2 (50.0) 4 (100.0) N/A
 Total 4 2 (50.0) 3 (75.0) 0.317 2 (50.0) 4 (100.0) N/A

Categorical variables are reported as frequencies (%).

LDL-C = low density lipoprotein cholesterol.

Table 4.
Differences in variation from baseline to 3 months after Lipilou® prescription
Variables Baseline Visit 1 p value
ALT 28±36 27±22 0.797
AST 26±26 27±29 0.684
BUN 16.2±6.7 16.3±7.6 0.555
Creatinine 0.9±0.5 1.0±0.6 0.460
GFR 78.3±20.5 78.5±21.2 0.695

ALT = alanine aminotransferase; AST = aspartate aminotransferase; BUN = blood urea nitrogen; GFR = glomerular filtration rate.

  • 1. World Health Organization, World Heart Federation, World Stroke Organization. Global Atlas on Cardiovascular Disease Prevention and Control: Policies, Strategies and Interventions. Geneva, World Health Organization. 2011.
  • 2. World Health Organization. Cardiovascular diseases [Internet] Geneva: World Health Organization; 2020 [cited 2020 May 23]. Available from: https://www.who.int/health-topics/cardiovascular-diseases
  • 3. World Health Organization. Hearts: technical package for cardiovascular disease management in primary health care [Internet] Geneva: World Health Organization; 2016 [cited 2020 May 23]. Available from: https://www.who.int/health-topics/cardiovascular-diseases
  • 4. Roth GA, Fihn SD, Mokdad AH, Aekplakorn W, Hasegawa T, Lim SS. High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries. Bull World Health Organ 2011;89:92-101.ArticlePubMed
  • 5. Anderson TJ, Mancini GB, Genest J Jr, Grégoire J, Lonn EM, Hegele RA. The new dyslipidemia guidelines: what is the debate? Can J Cardiol 2015;31:605-12.ArticlePubMed
  • 6. Kim HC. Epidemiology of dyslipidemia in Korea. J Korean Med Assoc 2016;59:352-7.Article
  • 7. European Association for Cardiovascular Prevention & Rehabilitation, Reiner ZCatapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, Agewall S, Alegria E, Chapman MJ, Durrington P, Erdine S, Halcox J, Hobbs R, Kjekshus J, Filardi PP, Riccardi G, Storey RF, Wood D; ESC Committee for Practice Guidelines (CPG) 2008-2010 and 2010-2012 Committees. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011;32:1769-818.PubMed
  • 8. Goff DC Jr, Lloyd-Jones DM, Bennett G, Coady S, D'Agostino RB Sr, Gibbons R, Greenland P, Lackland DT, Levy D, O'Donnell CJ, Robinson JG, Schwartz JS, Shero ST, Smith SC Jr, Sorlie P, Stone NJ, Wilson PW. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;63 25 Pt B:2935-59.
  • 9. Franco OH, Peeters A, Looman CW, Bonneux L. Cost effectiveness of statins in coronary heart disease. J Epidemiol Community Health 2005;59:927-33.ArticlePubMedPMC
  • 10. Ward S, Lloyd Jones M, Pandor A, Holmes M, Ara R, Ryan A, Yeo W, Payne N. A systematic review and economic evaluation of statins for the prevention of coronary events. Health Technol Assess 2007;11:1-160.Article
  • 11. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WM, Vlachopoulos C, Wood DA, Zamorano JL. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2016;253:281-344.ArticlePubMed
  • 12. Jellinger PS. American Association of Clinical Endocrinologists/American College of Endocrinology Management of Dyslipidemia and Prevention of Cardiovascular Disease Clinical Practice Guidelines. Diabetes Spectr 2018;31:234-45.ArticlePubMedPMC
  • 13. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O, Mueller C, Drexel H, Aboyans V, Corsini A, Doehner W, Farnier M, Gigante B, Kayikcioglu M, Krstacic G, Lambrinou E, Lewis BS, Masip J, Moulin P, Petersen S, Petronio AS, Piepoli MF, Pintó X, Räber L, Ray KK, Reiner Ž, Riesen WF, Roffi M, Schmid JP, Shlyakhto E, Simpson IA, Stroes E, Sudano I, Tselepis AD, Viigimaa M, Vindis C, Vonbank A, Vrablik M, Vrsalovic M, Zamorano JL, Collet JP, Koskinas KC, Casula M, Badimon L, John Chapman M, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O, Windecker S, Aboyans V, Baigent C, Collet JP, Dean V, Delgado V, Fitzsimons D, Gale CP, Grobbee D, Halvorsen S, Hindricks G, Iung B, Jüni P, Katus HA, Landmesser U, Leclercq C, Lettino M, Lewis BS, Merkely B, Mueller C, Petersen S, Petronio AS, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Touyz RM, Nibouche D, Zelveian PH, Siostrzonek P, Najafov R, van de Borne P, Pojskic B, Postadzhiyan A, Kypris L, Špinar J, Larsen ML, Eldin HS, Viigimaa M, Strandberg TE, Ferrières J, Agladze R, Laufs U, Rallidis L, Bajnok L, Gudjónsson T, Maher V, Henkin Y, Gulizia MM, Mussagaliyeva A, Bajraktari G, Kerimkulova A, Latkovskis G, Hamoui O, Slapikas R, Visser L, Dingli P, Ivanov V, Boskovic A, Nazzi M, Visseren F, Mitevska I, Retterstøl K, Jankowski P, Fontes-Carvalho R, Gaita D, Ezhov M, Foscoli M, Giga V, Pella D, Fras Z, de Isla LP, Hagström E, Lehmann R, Abid L, Ozdogan O, Mitchenko O, Patel RS; ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020;41:111-88.ArticlePubMed
  • 14. Chan JC, Kong AP, Bao W, Fayyad R, Laskey R. Safety of atorvastatin in Asian patients within clinical trials. Cardiovasc Ther 2016;34:431-40.ArticlePubMed
  • 15. Kim HS, Kim H, Lee H, Park B, Park S, Lee SH, Cho JH, Song H, Kim JH, Yoon KH, Choi IY. Analysis and comparison of statin prescription patterns and outcomes according to clinical department. J Clin Pharm Ther 2016;41:70-7.ArticlePubMed
  • 16. Kajinami K, Takekoshi N, Matsui S, Kanemitsu S, Okubo S, Kanayama S, Yamashita N, Sato R. Effect of pretreatment vitamin D levels on in vivo effects of atorvastatin on bone metabolism in patients with heterozygous familial hypercholesterolemia. Am J Cardiol 2003;92:1113-6.ArticlePubMed
  • 17. Mukhtar RY, Reid J, Reckless JP. Pitavastatin. Int J Clin Pract 2005;59:239-52.ArticlePubMed
  • 18. Diabetes Canada Clinical Practice Guidelines Expert Committee, Mancini GBJ, Hegele RA, Leiter LA. Dyslipidemia. Can J Diabetes 2018;42 Suppl 1:S178-85.ArticlePubMed
  • 19. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R; Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005;366:1267-78.ArticlePubMed
  • 20. Zhang D, Ge L, Li J, Li X, Feng F, Chen YP, Chen ZM, Martin L, Jane A, Chen F, Jiang LX; HPS2-THRIVE Collaborative Group. Current statin use for patients with atherosclerotic cardiovascular disease in 39 large Chinese hospitals. Zhonghua Xin Xue Guan Bing Za Zhi 2011;39:397-401.PubMed
  • 21. Lin YC, Yang CC, Chen YJ, Peng WC, Li CY, Hwu CM. Utilization of statins and aspirin among patients with diabetes and hyperlipidemia: Taiwan, 1998-2006. J Chin Med Assoc 2012;75:567-72.ArticlePubMed
  • 22. Korean Society of Lipid and Atherosclerosis. Dyslipidemia fact sheets in Korea 2018 [Internet] Seoul: Korean Society of Lipid and Atherosclerosis; 2018 [cited 2020 May 23]. Available from: https://www.lipid.or.kr/file/Dyslipidemia%20Fact%20Sheets%20in%20Korea%202018.pdf
  • 23. Kim SH, Park K, Hong SJ, Cho YS, Sung JD, Moon GW, Yoon MH, Lee MY, Hyon MS, Kim DW, Kim HS. Efficacy and tolerability of a generic and a branded formulation of atorvastatin 20 mg/d in hypercholesterolemic Korean adults at high risk for cardiovascular disease: a multicenter, prospective, randomized, double-blind, double-dummy clinical trial. Clin Ther 2010;32:1896-905.ArticlePubMed
  • 24. Hong SJ, Choi SY, Han SH, Choi YJ, Ahn T. Safety and tolerability of atorvastatin calcium anhydrous in Korean patients with dyslipidemia: an interim analysis from the lamp study. Atherosclerosis 2017;263:e236.Article
  • 25. Kim HS, Lee SH, Kim H, Lee SH, Cho JH, Lee H, Yim HW, Kim SH, Choi IY, Yoon KH, Kim JH. Statinrelated aminotransferase elevation according to baseline aminotransferases level in real practice in Korea. J Clin Pharm Ther 2016;41:266-72.ArticlePubMed
  • 26. Kim HS, Lee S, Kim JH. Real-world evidence versus randomized controlled trial: clinical research based on electronic medical records. J Korean Med Sci 2018;33:e213.ArticlePubMedPMC
  • 27. Kim HS, Kim JH. Proceed with caution when using real world data and real world evidence. J Korean Med Sci 2019;34:e28.ArticlePubMedPMC

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    • Understanding and Utilizing Claim Data from the Korean National Health Insurance Service (NHIS) and Health Insurance Review & Assessment (HIRA) Database for Research
      Dae-Sung Kyoung, Hun-Sung Kim
      Journal of Lipid and Atherosclerosis.2022; 11(2): 103.     CrossRef

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