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Pattern of statin use in several Hospitals in Jakarta. A cross sectional study
Article · July 2006
CITATION 1
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4 authors, including:
Some of the authors of this publication are also working on these related projects:
Usage of Statins in District Hospital of Mollucan Province-IndonesiaView project
Medical microbiology and parasitologyView project Abraham Simatupang
Universitas Kristen Indonesia 27PUBLICATIONS 50CITATIONS
Pattern of stalin use in several Hospitals in Jakarta.A cross
sectional study
A b ra h a m S im a tu p a n g1 , A d e n a n Iria n t0 2 , W a ld e m a r S im a n ju n ta k3, S a h a la
P a n g g a b e a n4
lD epartm ent of P hannacology and Teaching H ospital, C hristian U niversity of Indonesia School of
M edicine, Jakarta
ZP antai Indah K apuk H ospital, Jakarta 3pertam ina G eneral H ospital, Jakarta
4D epartm ent of Internal M edicine and Teaching H ospital, C hristian U niversity of Indonesia School of
M edicine, Jakarta.
K E Y W O R D S statins; efficacy; hypercholesterolem ia; drug com bination
A B ST R A C T
A
prelim inary, cross-sectional study on the pattern of statins use in three hospitals in Jakarta w as conducted to see the responder rate of the patients w ho took statins. D ata w ere taken from theM edical R ecords from M ay-July 2004 of each hospital. T he inclusion criteria w ere outpatients diagnosed w ith dyslipidem ia treated w ith statins either as first choice or add-on therapy to the other
lipid-low ering drugs given. T w o hundred and forty three cases w ere recorded during the 3-m onth
period of exam ination, 1 2 7 m ale and 1 1 6fem ale. T he average age of both group ofpatients w ere 56
:t1 2 years (m ale) and 5 5 :t1 2 years (fem ale). T he m ost com m only used statins as first choice and
as add-on w as atorvastatin (3 8 .1 % , and 1 .6 % , respectively), follow ed by rosuvastatin (20.5% ),
fluvastatin (1 1 .5 % ), pravastatin (10.7% );w hereas lovastatin (0.4% )and sim vastatin (3 .7 % ) w ere least prescribed. P atients' total cholesterol levels w ere reduced significantly (2 4 1 :t5 7 vs 207 :t38 m g/dL , p
<
0.0001), w hereas triglyceride levels w ere not significantly reduced (1 7 4 :t86 vs 160:t71 m g/dL ). A round 4 6 % cases (7 2 out of 2 4 3 cases) m et the N C E P A T P III goals on total
cholesterol level. T he m ost com m on com binations used, w ith respect to atorvastatin, w ere
fenofibrate (1 1 .3 % ), pravastatin (9 .3 % ), rosuvastatin (3 % ), gem fibrozil (2 % ), w hereas, w ith
regard to rosuvastati, w ere gem fibrozil (9 % ), ciprofibrate (5 % ), and atorvastatin (3 % ). L arge
num bers of patients w ere not regularly checked up o r low in com pliance. In conclusion, statins
usage in som e hospitals in Jakarta had been inappropriately used, due to m ultiple factors, such as,
prescribers, patients' aspects, and the national health system . T herefore, in order to observe the
efficacy of statins in clinical setting, a large scale study on the pattern of statin use should be
conducted.
M a n y s tu d ie s re v e a l th a t lo w b lo o d c h o
-le s te ro l c o n c e n tra tio n s u b s ta n tia lly lo w e rs th e in c id e n c e o f m y o c a rd in fa rc t a n d a n y o th e r c a r-d io v a s c u la r r-d is e a s e s (L e v in e et aI, 1 9 9 5 ; H u g h e s 1 9 9 7 ). T h e firs t e ffo rt o ffe re d fo r p a tie n ts to lo w e r
th e ir c h o le s te ro l le v e l in b lo o d is b y c h a n g in g life s ty le s , w h ic h in c lu d e re d u c in g b o d y w e ig h t, m o re
v ig o ro u s d a ily a c tiv ity a n d s m o k in g c e s s a tio n . H o w e v e r, th e s e e ffo rts c o u ld o n ly re d u c e th e
c h o le s te ro l le v e l u p to 1 5 % . F o r m o s t o f th e c a s e s , p h a rm a c o lo g ic a l a p p ro a c h , in th e e n d , is c o n s id e re d b y g iv in g a s p e c ific lip id lo w e rin g d ru g . T h e re a re 5 c la s s e s o f lip id -lo w e rin g d ru g s o b ta in a b le i.e . s ta tin s , n ia c in , b ile a c id s b in d in g re s in s , fib ra te s , a n d c h o le s -te ro l a b s o rp tio n in h ib ito r (e z e tim ib e ) (M a h le y a rid
B e rs o t,2 0 0 1 ].
S ta tin s (3 _ 0 H -3 -m e th y lg lu ta ry l-C o A re d u c ta s e
in h ib ito r) a re g ro u p o f lip id lo w e rin g d ru g s , w h ic h
a re v e ry e ffe c tiv e in lo w e rin g th e c o ro n a ry a rte ry
in c id e n c e s h o w n in m a n y p rim a ry a n d s e c o n d a ry p re v e n tio n s tu d ie s . T h e re a re n o w a t le a s t s e v e n ty p e s o f s ta tin s , w h ic h a re a v a ila b le in th e m a rk e t. T h e firs t o b ta in a b le s ta tin s a re lo v a s ta tin , p ra v a s ta tin a n d s im v a s ta tin , a ll o f w h ic h h a v e s h o w n s o m e re m a rk a b le re s u lts o n lo w e rin g th e in c id e n c e o f
c a rd io v a s c u la r d is e a s e s (A n o n y m o u s , 1 9 9 9 ; L IP ID , 1 9 9 8 ; H e a rt P ro te c tio n S tu d y C o lla b o ra -tiv e G ro u p ,
C orrespondence:
D r.m ed.A braham Sim afupang, dr.,M K es., D epartm ent of P hannaco-logy and Teaching H ospital, C hristian U niuersity of Indonesia School of M edicine, Jakarta, Jalan M ayjen Sutoyo, C aw ang Jakarta
13630, Telephone (021) 8009190, 8092524, F acsim ile 8093133
4 .5
%
2 .5%
1 .6
%
2 .0 %T a b le 2 . T h e m o s t f r e q u e n tly p r e s c r ib e d s ta tin s in th e p a r tic u la r h o s p ita ls s e ttin g
T y p e o f s ta tin s A s f ir s t c h o ic e A s a d d - o n
S im v a s ta tin 3 .7 %
P r a v a s ta tin 1 0 .7 %
F lu v a s ta tin 1 1 .5 %
A to r v a s ta tin 3 8 .1 %
R o s u v a s ta tin 2 0 .5
%
L o v a s ta tin 0 .4 %
400
350
300
250
200
•••
ti;~;=f;~~;~"
150
100
S im v a P r a v a F lu v a A to r v a R o s u v a
F ig u r e 1 . T h e e f f e c t o f v a r io u s s ta tin s o n th e le v e l o f T o ta l C h o le s te r o l. T h e d o tte d lin e s h o w s th e m in im u m
le v e l o f T C a c c o r d in g to th e N C E P A T P ill g o a ls .
400
300
200
1 0 0
S im v a P r a v a F lu v a A to r v a R o s u v a
F ig u r e 2 . T h e e f f e c t o f v a r io u s s ta tin s o n th e le v e l o f T r ig ly c e r id e s . T h e d o tte d lin e s h o w s th e m in im u m
2 2 6 A B R A H A M S I M A T U P A N G , A D E N A N I R I A N T O , W A L D E M A R S I M A N J U N T A K , S A H A L A P A N G G A B E A N
T a b l e 3 . T h e e f f e c t o f v a r i o u s s t a t i n s o n t o t a l c h o l e s t e r o l l e v e l
T y p e o f s t a t i n s T o t a l C h o l e s t e r o l
(mgj
d L ; M e a n : t S D ) P r e t r e a t m e n t D u r i n g & P o s t t r e a t m e n tS i m v a s t a t i n 2 2 6 . 5 : t 4 5 1 9 0 : t 2 2 . 7
P r a v a s t a t i n 2 2 0 : t 4 0 2 1 5 : t 4 0
F l u v a s t a t i n 2 3 6 : t 4 1 . 5 2 0 5 : t 2 8
A t o r v a s t a t i n 2 2 7 : t 5 2 . 6 1 9 6 : t 3 5
R o s u v a s t a t i n 2 4 7 : t 1 0 9 2 0 6 : t 5 1
T o t a l 2 4 1 : t 5 7 2 0 7 : t 3 8 *
*p<0.001
T a b l e 4 . T h e e f f e c t o f v a r i o u s s t a t i n s o n t r i g l y c e r i d e s l e v e l
T y p e o f s t a t i n s T r i g l y c e r i d e s ( m g j d L ; M e a n : t S D )
P r e t r e a t m e n t D u r i n g
&
P o s t t r e a t m e n tS i m v a s t a t i n 2 0 3 . 5 : t 4 5 1 3 6 : t 3 7
P r a v a s t a t i n 1 3 8 : t 3 0 1 2 7 : t 7 4
F l u v a s t a t i n 2 3 4 : t 6 1 . 5 1 5 1 : t 6 0
A t o r v a s t a t i n 1 4 1 :t 6 8 1 4 2 : t 6 8
R o s u v a s t a t i n 1 7 6 : t 6 1 1 5 9 : t 6 5
T o t a l 1 7 4 : t 8 6 1 6 0 : t 7 1
T a b l e 5 . T h e p e r c e n t a g e o f r e s p o n d e r s i n a c c o r d a n c e w i t h t h e A T P i l l c r i t e r i a
A l l t y p e o f s t a t i n s
S i m v a s t a t i n
P r a v a s t a t i n
F l u v a s t a t i n
A t o r v a s t a t i n
R o s u v a s t a t i n
A t o r v a
+
( p r a v a ; , f i b r a t e ,g e m f i b r o z i l )
Percentage of responder population
4 6 . 4 5 % ( 7 2 o u t o f 1 5 5 c a s e s )
0 . 6 5 %
3 . 2 2 %
1 . 3 3 %
1 7 . 4 2 %
5 . 1 6 %
0 . 6 5 % , 0 . 6 5 % , 0 . 6 5 % , r e s p e c t i v e l y
T a b l e 6 . T h e m o s t l i p i d - l o w e r i n g d r u g c o m b i n a t i o n s u s e d w i t h s t a t i n s
F e n o f i b r a t e
P r a v a s t a t i n
R o s u v a s t a t i n
G e m f i b r o z i l
F l u v a s t a t i n
C i p r o f i b r a t e
A t o r v a s t a t i n
A t o r v a s t a t i n
( 9 4 c a s e s )
1 1 . 3 % ( 1 1 )
9 . 3 % ( 9 )
3 . 0 % ( 3 )
2 . 0 % ( 2 )
1 . 0 % ( 1 )
1 . 0 % ( 1 )
R o s u v a s t a t i n
( 5 5 c a s e s )
9 . 0 % ( 5 )
5 . 0 % ( 3 )
L e v i n e G N , K e a n e y J F a n d V i t a J A 1 9 9 5 . C h o l e s t e r o l r e d u c
-t i o n i n c a r d i o v a s c u l a r d i s e a s e . C l i n i c a l b e n e f i t s a n d
p o s s i b l e m e c h a n i s m s . N e w E n g l J M e d ; 3 2 2 : 5 1 2 - 5 2 1 .
L o n g T e r m I n t e r v e n t i o n w i t h P r a v a s t a t i n i n I s c h a e m i c
D i s e a s e ( L I P I D ) S t u d y G r o u p 1 9 9 8 . P r e v e n t i o n o f
c a r d i v a s c u I a r e v e n t s a n d d e a t h w i t h p r a v a s t a t i n i n
p a t i e n t s w i t h c o r o n a r y h e a r t d i s e a s e a n d a ! > r o a d r a n g e
o f i n i t i a l c h o l e s t e r o l l e v e l s . N e w E n g l J M e d ; 3 3 9 :
1 3 4 9 - 5 7 .
M a h l e y R W , B e r s o t T P 2 0 0 1 . D r u g T h e r a p y f o r H y p e r c h o
-l e s t e r o -l e m i a a n d D y s l i p i d e m i a i n J G H a r d m a n , L E
L i m b i r ~ a n d A G G i l m a n ( e d s . ) : G o d d m a n & G i l m a n 's
t h e P h a r m a c o l o g i c a l B a s i s o f T h e r a p e u t i c s . N e w Y o r k :
M c G r a w - H i l l , p 9 7 1 - 1 0 0 2 .
M i l l e r D B a n d S p e n c e , J D 1 9 9 8 . C l i n i c a l p h a r m a c o k i n e t i c s o f
f i b r i c a c i d d e r i v a t i v e s ( f i b r a t e s ) . C l i n P h a r m a c o k i n e t
3 4 : 1 5 5 - 1 6 2
N a t i o n a l I n s t i t u t e o f H e a l t h 2 0 0 1 . T h i r d R e p o r t o f t h e
N a t i o n a l C h o l e s t e r o l E d u c a t i o n P r o g r a m ( N C E P )
E x p e r t P a n e l o n D e t e c t i o n , e v a l u a t i o n , a n d t r e a t t n e n t
o f h i g h b l o o d c h o l e s t e r o l i n a d u l t s ( A d u l t s T r e a t m e n t
P a n e l I I I ) . , "
N a s h D T 1 9 9 6 . M e e t i n g n a t i o n a l c h o l e s t e r o l e d u c a t i o n
g o a l s i n c l i n i c a l p r a c t i c e - a c o m p a r i s o n o f l o v a s t , a t i n
a n d f l u v a s t a t i n i n p r i n i a r y p r e v e n t i o n . A m J C a t d i o l ;
7 8 : 2 6 - 3 1 .
" ,
P a c k h a m C , P e a r s o n J , R o b i n s o n J , G r a y D 2 0 0 0 . U s e o f s t a t i n s i n g e n e r a l p r a c t i c e s , 1 9 9 6 - 8 : c r o s s - s e c t i o n a l
s t u d y . B M J . 3 2 0 : 1 5 8 3 - 1 5 8 4 .
P r i m a t e s t a P , P o u l t e r N R 2 0 0 0 . L i p i d c o n c e n t r a t i o n s a n d
t h e u s e o f l i p i d l o w e r i n g d r u g s : e v i d e n c e f r o m a
n a t i o n a l c r o s s s e c t i o n a l s u r v e y . B M J . 3 2 1 : 3 2 2 - 3 2 5 .
S c h w e d A , F a l l a b C L , B u r n i e r M , W a e b e r B , e t a l . 1 9 9 9 .
E l e c t r o n i c m o n i t o r i n g o f c o m p l i a n c e t o l i p i d - l o w e r i n g
t h e r a p y i n c l i n i c a l p r a c t i c e . J C l i n P h a r m a c o l ; 3 9 : 4 0 2
-4 0 9 .
S i g u r d s s o n G , H a r a l d s d o t t i r S O , M e l b e r g T H , e t a l . 1 9 9 8 .
S i m v a s t a t i n c o m p a r e d t o f l u v a s t a t i n i n t h e r e d u c t i o n
o f s e r u m l i p i d s a n d a p o l i p o p r o t e i n s i n p a t i e n t s w i t h
i s c h a e m i c h e a r t d i s e a s e a n d m o d e r a t e h y p e r c h o l e s
-t e r o l a e m i a . A c -t a C a r d i o l ; 5 8 : 7 - 1 4 .
S t e i n E S 2 0 0 3 . T h e P o w e r o f S t a t i n s : A g g r e s s i v e L i p i d
L o w e r i n g . C l i n C a r d i o l . 2 6 ( S u p p l . I I I ) : i l l - 2 5 - i l l 3 1 .
U l r i c h S , H i n g o r a n i A D , M a r t i n J , V a l l a n c e P 2 0 0 0 . W h a t i s
t h e o p t i m a l a g e f o r s t a r t i n g l i p i d l o w e r i n g t r e a t m e n t ?
A m a t h e m a t i c a l m o d e l . B M J ; 3 2 0 : 1 1 3 4 - 1 1 4 0 .
V a n H o u t B A a n d S i m o o n s M L 2 0 0 1 . C o s t - e f f e c t i v e n e s s o f
H M G c o e n z y m e r e d u c t a s e i n h i b i t o r s . W h o m t o t r e a t ?
E u r o p e a n H e a r t J o u r n a l 2 2 , 7 5 1 - 7 6 1 .
W h i t e R D , S i m e s J , A n d e r s o n M E , e t a l . 2 0 0 0 . P r a v a s t a t i n
T h e r a p y a n d t h e R i s k o f S t r o k e . N E n g J M e d . 3 4 3 : 3 1 7
