Archief Roodbont

Very low LDL targets attainable with statin-based therapy

25 March 2010

MedWire News: Very low target levels of low-density lipoprotein (LDL) cholesterol are achievable through statin-based therapy, a study of very-high-risk heart patients has found.

The study authors report that nearly half of patients in a real-world practice attained the LDL cholesterol goal of less than 70 mg/dl (1.81 mmol/l), as recommended in the revised National Cholesterol Education Program guidelines for very-high-risk patients with coronary artery disease (CAD).

The study was a retrospective, cross-sectional analysis of patients in the Kaiser Permanente Colorado healthcare system aged 18 years and above and with CAD and a predetermined LDL cholesterol goal of less than 70 mg/dl (1.81 mmol/l).

In all, 3226 of 7427 patients (43%) attained the goal, report Amy Kauffman (University of Colorado, Denver, USA) and colleagues in the Journal of Clinical Lipidology.

Patients who achieved their LDL goal were significantly more likely to be receiving a statin – either alone or in combination – than were patients not at goal (92.4% vs 81.3%).

Among those who attained the goal, 61.1% were receiving statin monotherapy, 70.7% were taking a moderate-to-high-potency statin, and 87.4% were taking a generic statin.

The remaining patients at goal were taking combination therapy, most often a statin in combination with ezetimibe (70.6%) or niacin (13.1%).

Multivariate analysis revealed several factors that were independently associated with failure to attain a LDL cholesterol of less than 70 mg/dl (1.81 mmol/l): age less than 65 years, female gender, hyperlipidemia diagnosis, and creatine kinase levels in the range 861–2000 IU/l.

Conversely, factors that independently predicted goal attainment were statin therapy (monotherapy or in combination), a history of gout, a higher body mass index, a greater level of cardiovascular risk, and a higher burden of chronic disease.

“Despite reporting a higher percentage of patients attaining a LDL cholesterol of less than 70 mg/dl treatment goal compared to previous studies, under 50% attained goal in a system which includes aggressive implementation and titration of lipid-lowering therapies and close monitoring and follow-up for all patients,” Kauffman and co-authors remark.

They conclude: “These data demonstrate the difficulty in attaining a LDL cholesterol of less than 70 mg/dl in the vast majority of patients with CAD.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

J Clin Lipidol 2010; Advance online publication