51% of Patients on Statins Are Not Reaching Optimal LDL-C Levels

More than half of the individuals who initiate statin therapy to prevent cardiovascular disease (CVD) will not optimally lower their low-density lipoprotein cholesterol (LDL-C) within the first 2 years of treatment, according to a new study. Moreover, these individuals have a significantly greater risk for later developing CVD, the researchers say.

To reach this conclusion, the researchers analyzed data on 165,411 primary care patients from the UK Clinical Practice Research Datalink. These participants—who initiated statin therapy between September 3, 1990, and June 7, 2016—did not have CVD prior to starting statin therapy. They also had at least 1 pre-treatment LDL-C measurement within a year before therapy initiation and 1 post-treatment LDL-C measurement within 2 years after initiation. 

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A sub-optimal LDL-C response was defined as having less than a 40% reduction in baseline LDL-C within 24 months. In all, 51.2% of the participants (84,609) had a sub-optimal LDL-C response.

Among all the participants, 22,798 CVD events occurred during 1,077,299 person-years of follow-up (median follow-up 6.2 years). Of those events, 12,142 occurred in those who had sub-optimal LDL-C responses and 10,656 occurred in those who had optimal responses. 

While those in the optimal group had a CVD rate of 19.7 per 1000 person-years, those in the sub-optimal group had a CVD rate of 22.6 per 1000 person-years.

This significant difference in CVD risk between the 2 groups continued even after adjusting for age and baseline untreated LDL-C value.

“Currently, there is no management strategy in clinical practice which takes into account patient variations in LDL-C response, and no guidelines for predictive screening before commencement of statin therapy,” the researchers concluded. “Validated clinical decision tools which can predict cholesterol response to statins, or to non-statin drugs, with interventions to help clinicians to tailor and optimize statin treatments for individual patients are needed.” 

—Colleen Murphy

Reference:

Akyea RK, Kai J, Qureshi N, Iyen B, Weng SF. Sub-optimal cholesterol response to initiation of statins and future risk of cardiovascular disease. Heart. 2019;105(13):975-981. doi:10.1136/heartjnl-2018-314253.