Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Società Italiana di Medicina Interna) Study

M. Bertolotti, A. Nobili, C. Mussi, P.M. Mannucci, M. Tettamanti, L. Pasina, F. Salerno, G.R. Corazza, M. Marcucci, G. Grignani, M. Bernardi, M. Barbagallo, M.D. Cappellini, G. Fabio, D. Mari, P.D. Rossi, E. Miceli, G. Murialdo, A. Marra, M.B. SecchiM. Carbone, M.R. Meroni, P. Gallo, M. Rubino, G. Martucci, M. Serra, M. Pala, M.R. Rizzo, F. Fontana, C. Bracco, S. Fargion, F. Peyvandi, A. Tedeschi, V. Monzani, V. Savojardo, C. Folli, M.M.F. Salerno, C.L. Balduini, G. Bertolino, S. Di Carlo, G.B. Bianchi, G. Vendemiale, A. Mirijello, A. Maresca, M. Serra, G.P. Martino, S. Messina, M. Cattaneo, C. Bussolino, M. Arcopinto, A.M. Marra, A. Ballestrero

Research output: Contribution to journalArticle

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Abstract

Background: Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. Aim: The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. Methods: We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. Results: 2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (≥5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment. Conclusions: In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients’ clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen. © 2017, Springer International Publishing Switzerland.
Original languageEnglish
Pages (from-to)311-319
Number of pages9
JournalDrugs and Aging
Volume34
Issue number4
DOIs
Publication statusPublished - Apr 2017

Fingerprint

Lipids
Polypharmacy
Pharmaceutical Preparations
Population
Comorbidity
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Simvastatin
Peripheral Vascular Diseases
Poisons
Therapeutics
Internal Medicine
Switzerland
Drug Interactions
Geriatrics
Prescriptions
Coronary Disease
Atherosclerosis
Logistic Models
Regression Analysis
Medicine

Keywords

  • antilipemic agent
  • atorvastatin
  • beta adrenergic receptor blocking agent
  • calcium channel blocking agent
  • colestyramine
  • dipeptidyl carboxypeptidase inhibitor
  • diuretic agent
  • ezetimibe
  • fenofibrate
  • fluindostatin
  • mevinolin
  • omega 3 fatty acid
  • pravastatin
  • proton pump inhibitor
  • rosuvastatin
  • sartan derivative
  • simvastatin
  • aged
  • Article
  • cohort analysis
  • cumulative scale
  • dyslipidemia
  • female
  • hospital patient
  • human
  • hypertension
  • ischemic heart disease
  • major clinical study
  • male
  • peripheral vascular disease
  • polypharmacy
  • prescription
  • primary prevention
  • priority journal
  • quantitative analysis
  • secondary prevention
  • hospitalization
  • prevalence
  • statistical model
  • very elderly
  • Aged
  • Aged, 80 and over
  • Female
  • Hospitalization
  • Humans
  • Hypolipidemic Agents
  • Logistic Models
  • Male
  • Polypharmacy
  • Prevalence

Cite this

@article{9c5386a6e7f54c8589256083f57be75e,
title = "Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Societ{\`a} Italiana di Medicina Interna) Study",
abstract = "Background: Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. Aim: The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. Methods: We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Societ{\`a} Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. Results: 2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4{\%}), with no gender difference. Atorvastatin (39.3{\%}) and simvastatin (34.0{\%}) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (≥5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment. Conclusions: In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients’ clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen. {\circledC} 2017, Springer International Publishing Switzerland.",
keywords = "antilipemic agent, atorvastatin, beta adrenergic receptor blocking agent, calcium channel blocking agent, colestyramine, dipeptidyl carboxypeptidase inhibitor, diuretic agent, ezetimibe, fenofibrate, fluindostatin, mevinolin, omega 3 fatty acid, pravastatin, proton pump inhibitor, rosuvastatin, sartan derivative, simvastatin, aged, Article, cohort analysis, cumulative scale, dyslipidemia, female, hospital patient, human, hypertension, ischemic heart disease, major clinical study, male, peripheral vascular disease, polypharmacy, prescription, primary prevention, priority journal, quantitative analysis, secondary prevention, hospitalization, prevalence, statistical model, very elderly, Aged, Aged, 80 and over, Female, Hospitalization, Humans, Hypolipidemic Agents, Logistic Models, Male, Polypharmacy, Prevalence",
author = "M. Bertolotti and A. Nobili and C. Mussi and P.M. Mannucci and M. Tettamanti and L. Pasina and F. Salerno and G.R. Corazza and M. Marcucci and G. Grignani and M. Bernardi and M. Barbagallo and M.D. Cappellini and G. Fabio and D. Mari and P.D. Rossi and E. Miceli and G. Murialdo and A. Marra and M.B. Secchi and M. Carbone and M.R. Meroni and P. Gallo and M. Rubino and G. Martucci and M. Serra and M. Pala and M.R. Rizzo and F. Fontana and C. Bracco and S. Fargion and F. Peyvandi and A. Tedeschi and V. Monzani and V. Savojardo and C. Folli and M.M.F. Salerno and C.L. Balduini and G. Bertolino and {Di Carlo}, S. and G.B. Bianchi and G. Vendemiale and A. Mirijello and A. Maresca and M. Serra and G.P. Martino and S. Messina and M. Cattaneo and C. Bussolino and M. Arcopinto and A.M. Marra and A. Ballestrero",
note = "Export Date: 6 March 2018 CODEN: DRAGE Correspondence Address: Bertolotti, M.; Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, Italy; email: marco.bertolotti@unimore.it Chemicals/CAS: atorvastatin, 134523-00-5, 134523-03-8; colestyramine, 11041-12-6, 58391-37-0; ezetimibe, 163222-33-1; fenofibrate, 49562-28-9; fluindostatin, 93957-54-1; mevinolin, 75330-75-5; pravastatin, 81093-37-0, 81131-70-6; rosuvastatin, 147098-18-8, 147098-20-2; simvastatin, 79902-63-9; Hypolipidemic Agents References: Spinewine, A., Adverse drug reactions in elderly people: the challenge of safer prescribing (2008) BMJ, 336, pp. 956-957. , PID: 18397946; American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults (2015) J Am Geriatr Soc, 63, pp. 2227-2246; Neaton, J.D., Wentworth, D., Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial Research Group (1992) Arch Intern Med, 152, pp. 56-64. , COI: 1:STN:280:DyaK387gt1ejsw{\%}3D{\%}3D, PID: 1728930; Castelli, W.P., Anderson, K., Wilson, P.W., Levy, D., Lipids and risk of coronary heart disease. 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year = "2017",
month = "4",
doi = "10.1007/s40266-017-0448-8",
language = "English",
volume = "34",
pages = "311--319",
journal = "Drugs and Aging",
issn = "1170-229X",
publisher = "Springer International Publishing",
number = "4",

}

TY - JOUR

T1 - Prevalence and Determinants of the Use of Lipid-Lowering Agents in a Population of Older Hospitalized Patients: the Findings from the REPOSI (REgistro POliterapie Società Italiana di Medicina Interna) Study

AU - Bertolotti, M.

AU - Nobili, A.

AU - Mussi, C.

AU - Mannucci, P.M.

AU - Tettamanti, M.

AU - Pasina, L.

AU - Salerno, F.

AU - Corazza, G.R.

AU - Marcucci, M.

AU - Grignani, G.

AU - Bernardi, M.

AU - Barbagallo, M.

AU - Cappellini, M.D.

AU - Fabio, G.

AU - Mari, D.

AU - Rossi, P.D.

AU - Miceli, E.

AU - Murialdo, G.

AU - Marra, A.

AU - Secchi, M.B.

AU - Carbone, M.

AU - Meroni, M.R.

AU - Gallo, P.

AU - Rubino, M.

AU - Martucci, G.

AU - Serra, M.

AU - Pala, M.

AU - Rizzo, M.R.

AU - Fontana, F.

AU - Bracco, C.

AU - Fargion, S.

AU - Peyvandi, F.

AU - Tedeschi, A.

AU - Monzani, V.

AU - Savojardo, V.

AU - Folli, C.

AU - Salerno, M.M.F.

AU - Balduini, C.L.

AU - Bertolino, G.

AU - Di Carlo, S.

AU - Bianchi, G.B.

AU - Vendemiale, G.

AU - Mirijello, A.

AU - Maresca, A.

AU - Serra, M.

AU - Martino, G.P.

AU - Messina, S.

AU - Cattaneo, M.

AU - Bussolino, C.

AU - Arcopinto, M.

AU - Marra, A.M.

AU - Ballestrero, A.

N1 - Export Date: 6 March 2018 CODEN: DRAGE Correspondence Address: Bertolotti, M.; Dipartimento Integrato di Medicina, Endocrinologia, Metabolismo e Geriatria, Azienda Ospedaliero-Universitaria di Modena, Nuovo Ospedale Civile, via Giardini 1355, Italy; email: marco.bertolotti@unimore.it Chemicals/CAS: atorvastatin, 134523-00-5, 134523-03-8; colestyramine, 11041-12-6, 58391-37-0; ezetimibe, 163222-33-1; fenofibrate, 49562-28-9; fluindostatin, 93957-54-1; mevinolin, 75330-75-5; pravastatin, 81093-37-0, 81131-70-6; rosuvastatin, 147098-18-8, 147098-20-2; simvastatin, 79902-63-9; Hypolipidemic Agents References: Spinewine, A., Adverse drug reactions in elderly people: the challenge of safer prescribing (2008) BMJ, 336, pp. 956-957. , PID: 18397946; American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults (2015) J Am Geriatr Soc, 63, pp. 2227-2246; Neaton, J.D., Wentworth, D., Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial Research Group (1992) Arch Intern Med, 152, pp. 56-64. , COI: 1:STN:280:DyaK387gt1ejsw%3D%3D, PID: 1728930; Castelli, W.P., Anderson, K., Wilson, P.W., Levy, D., Lipids and risk of coronary heart disease. 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PY - 2017/4

Y1 - 2017/4

N2 - Background: Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. Aim: The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. Methods: We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. Results: 2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (≥5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment. Conclusions: In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients’ clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen. © 2017, Springer International Publishing Switzerland.

AB - Background: Older patients are prone to multimorbidity and polypharmacy, with an inherent risk of adverse events and drug interactions. To the best of our knowledge, available information on the appropriateness of lipid-lowering treatment is extremely limited. Aim: The aim of the present study was to quantify and characterize lipid-lowering drug use in a population of complex in-hospital older patients. Methods: We analyzed data from 87 units of internal medicine or geriatric medicine in the REPOSI (Registro Politerapie della Società Italiana di Medicina Interna) study, with reference to the 2010 and 2012 patient cohorts. Lipid-lowering drug use was closely correlated with the clinical profiles, including multimorbidity markers and polypharmacy. Results: 2171 patients aged >65 years were enrolled (1057 males, 1114 females, mean age 78.6 years). The patients treated with lipid-lowering drugs amounted to 508 subjects (23.4%), with no gender difference. Atorvastatin (39.3%) and simvastatin (34.0%) were the most widely used statin drugs. Likelihood of treatment was associated with polypharmacy (≥5 drugs) and with higher Cumulative Illness Rating Scale (CIRS) score. At logistic regression analysis, the presence of coronary heart disease, peripheral vascular disease, and hypertension were significantly correlated with lipid-lowering drug use, whereas age showed an inverse correlation. Diabetes was not associated with drug treatment. Conclusions: In this in-hospital cohort, the use of lipid-lowering agents was mainly driven by patients’ clinical history, most notably the presence of clinically overt manifestations of atherosclerosis. Increasing age seems to be associated with lower prescription rates. This might be indicative of cautious behavior towards a potentially toxic treatment regimen. © 2017, Springer International Publishing Switzerland.

KW - antilipemic agent

KW - atorvastatin

KW - beta adrenergic receptor blocking agent

KW - calcium channel blocking agent

KW - colestyramine

KW - dipeptidyl carboxypeptidase inhibitor

KW - diuretic agent

KW - ezetimibe

KW - fenofibrate

KW - fluindostatin

KW - mevinolin

KW - omega 3 fatty acid

KW - pravastatin

KW - proton pump inhibitor

KW - rosuvastatin

KW - sartan derivative

KW - simvastatin

KW - aged

KW - Article

KW - cohort analysis

KW - cumulative scale

KW - dyslipidemia

KW - female

KW - hospital patient

KW - human

KW - hypertension

KW - ischemic heart disease

KW - major clinical study

KW - male

KW - peripheral vascular disease

KW - polypharmacy

KW - prescription

KW - primary prevention

KW - priority journal

KW - quantitative analysis

KW - secondary prevention

KW - hospitalization

KW - prevalence

KW - statistical model

KW - very elderly

KW - Aged

KW - Aged, 80 and over

KW - Female

KW - Hospitalization

KW - Humans

KW - Hypolipidemic Agents

KW - Logistic Models

KW - Male

KW - Polypharmacy

KW - Prevalence

U2 - 10.1007/s40266-017-0448-8

DO - 10.1007/s40266-017-0448-8

M3 - Article

VL - 34

SP - 311

EP - 319

JO - Drugs and Aging

JF - Drugs and Aging

SN - 1170-229X

IS - 4

ER -