Clinical Implications of Switching Lipid Lowering Treatment from Rosuvastatin to Other Agents in Primary CareReport as inadecuate

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Advances in Therapy

, Volume 33, Issue 11, pp 2049–2058

First Online: 26 September 2016Received: 03 August 2016DOI: 10.1007-s12325-016-0412-8

Cite this article as: Colivicchi, F., Gulizia, M.M., Franzini, L. et al. Adv Ther 2016 33: 2049. doi:10.1007-s12325-016-0412-8


IntroductionSwitching from any statin to another non-equipotent lipid lowering treatment LLT may cause a low-density lipoprotein cholesterol increase and has been associated with a higher probability of negative cardiovascular outcomes. The aim of the study was to assess the impact of switching from rosuvastatin to any other LLT on clinical outcomes in primary care.

MethodsThis was a retrospective analysis based on data from IMS Health Longitudinal Patient Database, which is a general practice database including information of more than 1.0 million patients representative of the Italian population by age, and medical conditions. Patients that started on rosuvastatin 10–40 mg-day between January 2011 and December 2013 were considered. The date of the first prescription was defined as the index date ID. The observation period lasted from the ID to September 2015 or until LLT discontinuation, or the occurrence of an acute myocardial infarction AMI, or death.

ResultsThe primary end point of the study was the occurrence of an AMI during the observation period. The final study population included 10,368 patients. During the observation period, 2452 23.6% patients were switched from rosuvastatin to another LLT. The majority of patients 55.6% were switched to atorvastatin, followed by simvastatin 24.9%, simvastatin-ezetimibe combination 10.0% and other statins 9.5%. Female gender HR, hazard ratio, 1.10, 95% CI, confidence interval, 1.02–1.19, p = 0.04 and the presence of chronic kidney disease HR 1.47, 95% CI 1.16–1.86, p = 0.05 were associated with a higher probability of switch. During the observation period, 113 patients experienced an AMI incidence of 6.7 AMI-1000 patient-years. Multivariate analysis with Cox proportional hazards method, including switching as a time-dependent covariate, demonstrated that changing from rosuvastatin to another LLT was an independent predictor of AMI HR 2.2, 95% CI 1.4–3.5, p = 0.001.

ConclusionWe conclude that switching from rosuvastatin to another non-equipotent LLT may impart an increased risk of AMI and should be avoided.

FundingAstraZeneca SpA.

KeywordsAcute myocardial infarction AMI Cox Endocrinology Hazard Incidence Lipid lowering Rosuvastatin Statin Switch Enhanced contentTo view enhanced content for this article go to

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Author: Furio Colivicchi - Michele Massimo Gulizia - Laura Franzini - Giuseppe Imperoli - Lorenzo Castello - Alessandro Aiello - Cl



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