Over half of patients on statins fail to achieve optimal cholesterol levels within two years

  • Akyea RK & al.
  • Heart
  • 15 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • In over half of patients in the general population, optimal lowering of low-density lipoprotein cholesterol (LDL-C) is not achieved within 2 years after starting statin therapy.
  • Risk of future cardiovascular disease (CVD) is significantly high in these patients vs those with an optimal cholesterol response.

Why this matters

  • At present, no management strategy exists in clinical practice which considers patient variations in LDL-C response, and there are no guidelines for predictive screening before starting statin therapy.
  • These findings contribute to the debate on the effectiveness of statin therapy and highlight the need for personalised medicine in lipid management.

Study design

  • Prospective study included 165,411 primary care patients (free of CVD before starting statins) from the UK Clinical Practice Research Datalink.
  • All patients had had their LDL-C measured at least once within 12 months and at least once within two years of statin initiation.
  • Funding: University of Nottingham.

Key results

  • LDL-C response was optimal in 84 609 (51.2%) patients at 24 months after initiating statin therapy. 
  • 22798 CVD events (12142 in sub-optimal responders and 10 656 in optimal responders) were reported during 1077299 person-years of follow-up (median follow-up 6.2 years).
  • Patients with a sub-optimal response were more likely to have an incident CVD vs those with an optimal response (crude HR 1.17; 95% CI, 1.13-1.20; P<.001>
  • After adjusting for age and baseline untreated LDL-C, the risk remained higher in sub-optimal responders (adjusted HR 1.22; 95% CI, 1.19-1.25; P<.001>


  • Risk of confounders.

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