- 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.
- 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.
- 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.