Statins at the Primary Care Level
Statins at the Primary Care Level
Hypercholesterolemia, a major cause of disease burden in both the developed and developing
 world, is estimated to cause 2.6 million deaths annually (4.5% of all deaths) and one third
 of ischemic heart diseases., and result in 29.7 million DALY lost. In Argentina, the
 prevalence of hypercholesterolemia increased between 2005 and 2013 from 27.9% to 29.8%,
 whereas the rate of non-optimal LDL-C, was 28.0%. The rate of high cholesterol awareness was
 37.3 % and the proportion of those who are under pharmacological treatment was dismally low:
 only 11.1%. Furthermore, only one out of four subjects with a self-reported diagnosis of
 coronary heart disease (CHD) is taking statins. and most individuals with CHD who are on
 statins have sub-optimal LDL-C levels. Although other antihypertensive, antidiabetic and
 low-dose aspirin were available free-of-charge at the primary care clinics of the public
 sector, statins had not been included until recently. As of 2014, statins (simvastatin 20mg)
 were incorporated into the package of drugs provided free-of-charge for patients with high
 cholesterol, according to CVD risk stratification. The goal of this study is to test whether
 a multifaceted educational intervention targeting physicians and pharmacist assistants,
 improves detection, treatment and control of hypercholesterolemia among uninsured patients
 with moderate to high cardiovascular risk in Argentina. Specifically, the intervention will
 test whether a multifaceted educational intervention program lowers LDL-cholesterol levels
 and CVD risk in moderate to high cardiovascular risk patients, improves physician compliance
 with clinical practice guidelines, and improves patient care management and adherence to
 medication. A cost-effectiveness study will be conducted to compare the intervention to the
 usual standard of care. This randomized cluster trial will enroll 350 patients from 10 public
 primary care clinics who will be assigned to receive either the intervention or the usual
 care. This study is timely and will generate urgently needed data on effective and, practical
 and sustainable intervention programs aimed at the prevention and control of CVD risk that
 can be directly used in other primary care settings and health care systems in LMICs.
Inclusion Criteria:

 -  Arteriosclerotic cardiovascular disease: defined as acute coronary syndrome; history
 of myocardial infarction, stable or unstable angina, coronary revascularization,
 stroke, or transient ischemic attack presumed to be of atherosclerotic origin and
 revascularization.

 -  Moderate-High CVD risk according to the WHO charts adapted by the National MoH
 (estimated 10-year CVD risk ≥ 20%)

 -  LDL-C level ≥ 190 mg/dL

 -  Type 2 diabetes in patients between 40 and 75 years of age

 Exclusion Criteria:

 -  Patients that are already receiving statins, pregnant women, bed-bound, and patients
 who cannot give informed consent.

 -  End stage chronics kidney disease receiving dialysis ,HIV/AIDS, tuberculosis, alcohol
 or drugs abuse.