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.

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

NOBILI, ALESSANDRO;CORAZZA, GINO ROBERTO;MARCUCCI, Maura;SILVESTRI, ELENA;BERNARDI, MAURO;SANTI, LUCA;ZACCHERINI, GIACOMO;MARI, DANIELA;BOLONDI, LUIGI;RASCITI, LEONARDO;SERIO, ILARIA;AMOROSO, ANTONIO;FRANCESCHI, FRANCESCO;BECCHI, MARIA ANGELA;BORGHI, CLAUDIO;STROCCHI, ENRICO;DE SANDO, VALERIA;FERRARI, BARBARA;LANDOLFI, RAFFAELE;DE GIORGIO, ROBERTO;SERRA, MAURO;GRASSO, VALENTINA;RUGGERI, EUGENIO;MINELLI, GIORGIO;MESSINA, SILVIA;CATTANEO, MARCO NATALE;GASPARINI, FRANCESCA;
2017

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.
Bertolotti, Marco; Franchi, Carlotta; Rocchi, Marco B. L.; Miceli, Andrea; Libbra, M. Vittoria; Nobili, Alessandro; Lancellotti, Giulia; Carulli, Lucia; Mussi, Chiara; On behalf of REPOSI Investigators [.. ; Mannucci, Pier Mannuccio; Nobili, Alessandro; Tettamanti, Mauro; Pasina, Luca; Franchi, Carlotta; Perticone, Francesco; Salerno, Francesco; Corrao, Salvatore; Marengoni, Alessandra; Licata, Giuseppe; Violi, Francesco; Corazza, Gino Roberto; Marcucci, Maura; Eldin, Tarek Kamal; Di Blanca, Maria Pia Donatella; Lanzo, Giovanna; Astuto, Sarah; Tettamanti, Mauro; Ardoino, Ilaria; Cortesi, Laura; Prisco, Domenico; Silvestri, Elena; Cenci, Caterina; Emmi, Giacomo; Biolo, Gianni; Guarnieri, Gianfranco; Zanetti, Michela; Fernandes, Giovanni; Chiuch, Massimiliano; Vanoli, Massimo; Grignani, Giulia; Casella, Gianluca; Pulixi, Edoardo Alessandro; Bernardi, Mauro; Bassi, Silvia Li; Santi, Luca; Zaccherini, Giacomo; Mannarino, Elmo; Lupattelli, Graziana; Bianconi, Vanessa; Paciullo, Francesco; Nuti, Ranuccio; Valenti, Roberto; Ruvio, Martina; Cappelli, Silvia; Palazzuoli, Alberto; Salvatore, Teresa; Sasso, Ferdinando Carlo; Girelli, Domenico; Olivieri, Oliviero; Matteazzi, Thomas; Barbagallo, Mario; Plances, Lidia; Alcamo, Roberta; Licata, Giuseppe; Calvo, Luigi; Valenti, Maria; Pasini, Franco Laghi; Capecchi, Pier Leopoldo; Bicchi, Maurizio; Palasciano, Giuseppe; Modeo, Maria Ester; Peragine, Maria; Pappagallo, Fabrizio; Pugliese, Stefania; Di Gennaro, Carla; Postiglione, Alfredo; Barbella, Maria Rosaria; De Stefano, Francesco; Cappellini, Maria Domenica; Fabio, Giovanna; Seghezzi, Sonia; De Amicis, Margherita Migone; Mancarella, Marta; Mari, Daniela; Rossi, Paolo Dionigi; Damanti, Sarah; Ottolini, Barbara Brignolo; Bonini, Giulia; Corazza, Gino Roberto; Miceli, Emanuela; Lenti, Marco Vincenzo; Padula, Donatella; Murialdo, Giovanni; Marra, Alessio; Cattaneo, Federico; Secchi, Maria Beatrice; Ghelfi, Davide; Anastasio, Luigi; Sofia, Lucia; Carbone, Maria; Davì, Giovanni; Guagnano, Maria Teresa; Sestili, Simona; Mancuso, Gerardo; Calipari, Daniela; Bartone, Mosè; Meroni, Maria Rachele; Perin, Paolo Cavallo; Lorenzati, Bartolomeo; Gruden, Gabriella; Bruno, Graziella; Amione, Cristina; Fornengo, Paolo; Tassara, Rodolfo; Melis, Deborah; Rebella, Lara; Delitala, Giuseppe; Pretti, Vincenzo; Masala, Maristella Salvatora; Pes, Chiara; Bolondi, Luigi; Rasciti, Leonardo; Serio, Ilaria; Fanelli, Filippo Rossi; Amoroso, Antonio; Molfino, Alessio; Petrillo, Enrico; Zuccalà, Giuseppe; Franceschi, Francesco; De Marco, Guido; Chiara, Cordischi; Marta, Sabbatini; D’Aurizio, Gabriella; Romanelli, Giuseppe; Amolini, Claudia; Chiesa, Deborah; Marengoni, Alessandra; Picardi, Antonio; Gentilucci, Umberto Vespasiani; Gallo, Paolo; Annoni, Giorgio; Corsi, Maurizio; Zazzetta, Sara; Bellelli, Giuseppe; Szabo, Hajnalka; Arturi, Franco; Succurro, Elena; Rubino, Mariangela; Sesti, Giorgio; Loria, Paola; Becchi, Maria Angela; Martucci, Gianfranco; Fantuzzi, Alessandra; Maurantonio, Mauro; Serra, Maria Grazia; Bleve, Maria Antonietta; Gasbarrone, Laura; Sajeva, Maria Rosaria; Brucato, Antonio; Ghidoni, Silvia; Di Corato, Paola; Agnelli, Giancarlo; Marchesini, Emanuela; Fabris, Fabrizio; Carlon, Michela; Turatto, Francesca; Baritusso, Aldo; Turatto, Francesca; Amabile, Annalisa; Omenetto, Elisabetta; Scarinzi, Paolo; Manfredini, Roberto; Molino, Christian; Pala, Marco; Fabbian, Fabio; Boari, Benedetta; De Giorgi, Alfredo; Paolisso, Giuseppe; Rizzo, Maria Rosaria; Laieta, Maria Teresa; Rini, Giovanbattista; Mansueto, Pasquale; Pepe, Ilenia; Borghi, Claudio; Strocchi, Enrico; De Sando, Valeria; Pareo, Ilaria; Sabbà, Carlo; Vella, Francesco Saverio; Suppressa, Patrizia; Valerio, Raffaella; Agosti, Pasquale; Fontana, Flavia; Loparco, Francesca; Pugliese, Stefania; Capobianco, Caterina; Fenoglio, Luigi; Bracco, Christian; Giraudo, Alessia Valentina; Testa, Elisa; Serraino, Cristina; Fargion, Silvia; Bonara, Paola; Periti, Giulia; Porzio, Marianna; Tiraboschi, Slivia; Peyvandi, Flora; Tedeschi, Alberto; Rossio, Raffaella; Ferrari, Barbara; Monzani, Valter; Savojardo, Valeria; Folli, Christian; Salerno, Maria Magnini Francesco; Conca, Alessio; Gobbo, Giulia; Conca, Alessio; Pallini, Giada; Valenti, Miriam; Balduini, Carlo L.; Bertolino, Giampiera; Provini, Stella; Quaglia, Federica; Dallegri, Franco; Ottonello, Luciano; Liberale, Luca; Chin, Wu Sheng; Carassale, Laura; Caporotundo, Silvia; Traisci, Giancarlo; De Feudis, Lucrezia; Di Carlo, Silvia; Liberato, Nicola Lucio; Buratti, Alberto; Tognin, Tiziana; Bianchi, Giovanni Battista; Giaquinto, Sabrina; Purrello, Francesco; Di Pino, Antonino; Piro, Salvatore; Rozzini, Renzo; Falanga, Lina; Spazzini, Elena; Montrucchio, Giuseppe; Greco, Elisabetta; Tizzani, Pietro; Petitti, Paolo; Perciccante, Antonio; Coralli, Alessia; Salmi, Raffaella; Gaudenzi, Piergiorgio; Gamberini, Susanna; Semplicini, Andrea; Gottardo, Lucia; Vendemiale, Gianluigi; Serviddio, Gaetano; Forlano, Roberta; Masala, Cesare; Mammarella, Antonio; Raparelli, Valeria; Violi, Francesco; Basili, Stefania; Perri, Ludovica; Landolfi, Raffaele; Montalto, Massimo; Mirijello, Antonio; Vallone, Carla; Bellusci, Martino; Setti, Donatella; Pedrazzoli, Filippo; Guasti, Luigina; Castiglioni, Luana; Maresca, Andrea; Squizzato, Alessandro; Molaro, Marta; Bertolotti, Marco; Mussi, Chiara; Libbra, Maria Vittoria; Miceli, Andrea; Pellegrini, Elisa; Carulli, Lucia; Veltri, Francesca; Perticone, Francesco; Sciacqua, Angela; Quero, Michele; Bagnato, Chiara; Colangelo, Lidia; Falbo, Tania; De Giorgio, Roberto; Serra, Mauro; Grasso, Valentina; Ruggeri, Eugenio; Ilaria, Benzoni; Salvi, Andrea; Leonardi, Roberto; Grassini, Chiara; Mascherona, Ilenia; Minelli, Giorgio; Maltese, Francesca; Damiani, Giampaolo; Capeci, William; Mattioli, Massimo; Martino, Giuseppe Pio; Biondi, Lorenzo; Ormas, Monica; Pettinari, Pietro; Romiti, Roberto; Corrao, Salvatore; Messina, Silvia; Cavallaro, Federica; Ghio, Riccardi; Favorini, Serena; Col, Anna Dal; Minisola, Salvatore; Colangelo, Luciano; Afeltra, Antonella; Alemanno, Pamela; Marigliano, Benedetta; Pipita, Maria Elena; Castellino, Pietro; Blanco, Julien; Zanoli, Luca; Cattaneo, Marco; Fracasso, Paola; Amoruso, Maria Valentina; Saracco, Valter; Fogliati, Marisa; Bussolino, Carlo; Durante, Vittorio; Eusebi, Giovanna; Tirotta, Daniela; Mete, Francesca; Gino, Miriam; Cittadini, Antonio; Vigorito, Carlo; Arcopinto, Michele; Salzano, Andrea; Bobbio, Emanuele; Marra, Alberto Maria; Sirico, Domenico; Moreo, Guido; Scopelliti, Francesco; Gasparini, Francesca; Cocca, Melissa; Ballestrero, Alberto; Ferrando, Fabio; Berra, Sergio; Dassi, Simonetta; Nava, Maria Cristina; Graziella, Bruno; Ghidoni, Silvia; Amione, Cristina; Baldassarre, Stefano; Fragapani, Salvatore; Gruden, Gabriella; Galanti, Giorgio; Mascherini, Gabriele; Petri, Cristian; Stefani, Laura; Girino, Margherita; Piccinelli, Valeria; Nasso, Francesco; Gioffrè, Vincenza; Pasquale, Maria; Scattolin, Giuseppe; Martinelli, Sergio; Turrin, Mauro; Sechi, Leonardo; Catena, Cristina; Colussi, Gianluca; Nieves, Ramirez Duque; Alberto, Muela Molinero; Pedro, Abad Requejo; Vanessa, Lopez Pelaez; Lara, Tamargo; Xavier, Corbella Viros; Francesc, Formiga; Jesus, Diez Manglano; Esperanza, Bejarano Tello; Esther, Del Corral Behamonte; Maria, Sevil Puras; Romero, Manuel; Blanca, Pinilla Llorente; Cristina, Lopez Gonzalez-Cobos; Victoria, Villalba Garcia M.; Saez, Lopez; Bosco, Juan; Susana, Sanz Baena; Marta, Arroyo Gallego; Concepcion, Gonzalez Becerra; Antonio, Fernandez Moyano; Hernandez, Mercedes Gomez; Borrego, Manuel Poyato; Raquel, Pacheco Cuadros; Florencia, Perez Rojas; Beatriz, Garcia Olid; Sara, Carrascosa Garcia; Alfonso, Gonzalez-Cruz Cervellera; Marta, Peinado Martinez; Garcia, Sara Carrascosa; Alberto, Ruiz Cantero; Antonio, Albarracín Arraigosa; Montserrat, Godoy Guerrero; Ángel, Barón Ramos Miguel; Manuel, Machin Jose; Ignacio, Novo Veleiro; Lucía, Alvela Suarez; Alfonso, Lopez; David, Rubal Bran; Iria, Iñiguez Vazquez; Monica, Rios Prego.. ;]
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