Suboptimal cholesterol lowering leads to higher CVD

Over half of patients fail to achieve optimal cholesterol lowering following statin initiation for primary prevention, and suffer higher rates of cardiovascular events as a result.

This is according to a prospective cohort study of 165 411 primary care patients, from the UK Clinical Practice Research Datalink, who were free of cardiovascular disease (CVD) before statin initiation.

51.2% of patients had a sub-optimal LDL-C response, assessed as less than 40% reduction in baseline LDL-C, within 24 months of statin initiation.

During 1 077 299 person-years of follow-up (median follow-up 6.2 years), there were 22 798 CVD events (12 142 in sub-optimal responders and 10 656 in optimal responders). In sub-optimal responders, compared with optimal responders, the hazard ratio (HR) for incident CVD was 1.17 (95% CI 1.13 to 1.20) and 1.22 (95% CI 1.19 to 1.25) after adjusting for age and baseline untreated LDL-C.

According to the authors the study highlights the benefit of reducing cholesterol to optimal values, which would lead to better cardiovascular outcomes for patients currently on statins. The reasons for the suboptimal responses could be individual biological and genetic variability in LDL-C response to statin therapy as well as variation in adherence, they say.

A strongly worded editorial accompanying the paper calls for more rigorous adherence to guidelines if the full benefits of statin therapy are to be realised. Antistatin propaganda based on pseudoscience should be demystified by health authorities and reassurance of statin safety should be emphasised to both doctors and patients in order to diminish excessive, unrealistic concerns, it says.

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