Sub-optimal cholesterol response to initiation of statins and future risk of cardiovascular disease.

Ralph Kwame Akyea, Joe Kai, Nadeem Qureshi, Barbara Iyen, Stephen F Weng

REVIEW


09 July 2019

This study confirms previous research highlighting how important it is to keep LDL-C low, however hard this is in clinical practice, and identifying patients with a poor response/adherence to statins. The high rate of poor responders to statins is definitely a worry.


RELEVANCE 3
INNOVATIVENESS 5
APPLICABILITY 4
OVERALL 4

PAPER DETAILS


TITLE

Sub-optimal cholesterol response to initiation of statins and future risk of cardiovascular disease.

ABSTRACT

OBJECTIVE
To assess low-density lipoprotein cholesterol (LDL-C) response in patients after initiation of statins, and future risk of cardiovascular disease (CVD).

METHODS
Prospective cohort study of 165 411 primary care patients, from the UK Clinical Practice Research Datalink, who were free of CVD before statin initiation, and had at least one pre-treatment LDL-C within 12 months before, and one post-treatment LDL-C within 24 months after, statin initiation. Based on current national guidelines, <40% reduction in baseline LDL-C within 24 months was classified as a sub-optimal statin response. Cox proportional regression and competing-risks survival regression models were used to determine adjusted hazard ratios (HRs) and sub-HRs for incident CVD outcomes for LDL-C response to statins.

RESULTS
84 609 (51.2%) patients had a sub-optimal LDL-C response to initiated statin therapy within 24 months. 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 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. Considering competing risks resulted in lower but similar sub-HRs for both unadjusted (1.13, 95% CI 1.10 to 1.16) and adjusted (1.19, 95% CI 1.16 to 1.23) cumulative incidence function of CVD.

CONCLUSIONS
Optimal lowering of LDL-C is not achieved within 2 years in over half of patients in the general population initiated on statin therapy, and these patients will experience significantly increased risk of future CVD.



AUTHOR(S)

Ralph Kwame Akyea, Joe Kai, Nadeem Qureshi, Barbara Iyen, Stephen F Weng,

JOURNAL

Heart (British Cardiac Society)

PLACE

England