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CARDIOLOGY

Comparing Hyperlipidemia Control with Daily Versus Twice-Weekly Simvastatin

Research Pharmacist, Southern Arizona Veterans Affairs HealthCare System; Research Associate, University of Arizona Center for Health Outcomes & Pharmaco-Economic Research, Tucson, AZ

Gisela I Robles, PharmD

at time of study, Pharmacy Practice Resident, Southern Arizona VA HealthCare System; now, Clinical Assistant Professor, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey; Clinical Pharmacist, Meridian Health System, Riverview Medical Center Division

William N Jones, MSPharm

Pharmacoeconomist, Program Manager for Pharmacy Clinical Services, Southern Arizona VA HealthCare System; Clinical Associate Professor of Pharmacy Practice and Science, College of Pharmacy, University of Arizona

Marjorie A Ford, PharmD

Clinical Pharmacist, Southern Arizona VA HealthCare System; Clinical Assistant Professor of Pharmacy Practice and Science, College of Pharmacy, University of Arizona

Steven P Thomson, MD

Endocrinology, Southern Arizona VA HealthCare System; Assistant Professor of Clinical Medicine, University of Arizona

Reprints: William N Jones MSPharm, Southern Arizona VA HealthCare System (5-119), 3601 S. Sixth Ave., Tucson, AZ 85723-0001, fax 520/629-1793, William.Jones{at}med.va.gov

BACKGROUND: Costs associated with the use of hydroxymethylglutaryl coenzyme A reductase inhibitors are increasing. Finding ways to manage hyperlipidemia at lower costs is critical to all healthcare systems.

OBJECTIVE: To assess effectiveness, safety, cost, and patients' satisfaction when converting hyperlipemic patients taking simvastatin daily to simvastatin twice weekly.

METHODS: This nonrandomized, open-label, proof-of-concept study converted patients treated with simvastatin 10 or 20 mg daily to 40 or 80 mg twice weekly, respectively, for 12 weeks. The lipid profiles at enrollment, week 6, and week 12 were compared using repeated-measures ANOVA. The percentage of patients attaining the appropriate low-density lipoprotein cholesterol (LDL-C) goal was determined.

RESULTS: Thirty-one patients completed the study. The proportion of patients at the LDL-C goal was not statistically different between enrollment and week 12 (87% vs 68%; p = 0.068). The mean LDL-C value ± SD at weeks 6 and 12 increased compared with enrollment (112 ± 20, 111 ±17, and 97 ± 17 mg/dL, respectively; p < 0.001). Three (10%) patients reported nonadherence to the twice-weekly regimen. Seventeen (55%) patients reported that both regimens were equally convenient or preferred the twice-weekly regimen. Estimated cost-savings at our institution associated with this regimen would be $32 000 per 1000 patients per year.

CONCLUSIONS: The twice-weekly regimen safely maintained most of the patients at their LDL-C goal level, and over half the patients found this regimen to be the same or easier to follow than a daily regimen. Large outcome studies evaluating this approach are needed.

Key Words: hyperlipidemia, low-density lipoprotein cholesterol, simvastatin

Published Online, October 12, 2004. www.theannals.com, DOI 10.1345/aph.1E134