In what extend we can reach the current LDL-cholesterol treatment goals in secondary prevention

Czech version

Authors: Otto Mayer Jr; Jan Bruthans V Zastoupení Řešitelů Projektu Euroaspire
Authors‘ workplace: Centrum preventivní kardiologie II. interní kliniky LF UK a FN Plzeň, přednosta prof. MUDr. Jan Filipovský, CSc.
Published in: Vnitř Lék 2015; 61(5): 439-446
Category: Original Contributions

Overview

Background:
A number of clinical trials have shown that patients with overt atherovascular disease may benefit from more aggressive dosage of statins. We aimed to determined the usual dosage of statin in clinical practice and the adherence to recommended target concentration of LDL-cholesterol.

Methods and results :
We analyzed 948 patients with mean age 64.5 years (SD ± 9.0) after acute coronary syndrome and/or coronary revascularization (Czech samples of EUROASPIRE III and IV). In spite that more than 93 % of patients were in 2012/2013 treated with statin, only 2.4 % with the highest dose (atorvastatin 80 mg or equivalent). On the other hand, medium-dosed statin (atorvastatin 40 mg) was more often prescribed, in comparison to 2006/2007. We observed mild improvement in adherence to former LDL-cholesterol target < 2.5 mmol/l (from 54 % to 65 %), but the recent target < 1.8 mmol/l was reached only in less than one quarter of patients in 2012/2013. It can be approximate (using individual LDL-cholesterol values), that after maximal possible up-titration of statin, the adherence to recent LDL-cholesterol target may improve up to 43 %.

Conclusions:
Although the majority of CHD patients are currently being treated with statin, the usual dosage regimen and adherence to the recommended target values were not consistent with current therapeutic standards for secondary prevention of CHD.

Key words:
dosage – EUROASPIRE – secondary prevention – statin – treatment target value

Sources

1. Baigent C, Keech A, Kearney PM et al. Cholesterol Treatment Trialists‘ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective metaanalysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005; 366(9493): 1267–1278.

2. Cannon CP, Braunwald E, McCabe CH et al. Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350(15): 1495–1502. Erratum in N Engl J Med 2006; 354(7): 778.

3. LaRosa JC, Grundy SM, Waters DD et al. Treating to New Targets Investigators, Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005; 352(14): 1425–1435.

4. de Lemos JA, Blazing MA, Wiviott SD et al. A-to-Z Investigators. Early intensive vs. a delayed conservative simvastatin strategy in patients with acute coronary syndromes phase Z of the A-to-Z trial. JAMA 2004; 292(11): 1307–1316.

5. Pedersen TR, Faergeman O, Kastelein JJ et al. Incremental Decrease in End Points Through Aggressive Lipid-Lowering Study Group. High-dose atorvastatin versus usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA 2005; 294(19): 2437–2445. Erratum in JAMA 2005 28; 294(24): 3092.

6. Cannon CP, Steinberg BA, Murphy SA et al. Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol 2006; 48(3): 438–445.

7. Graham I, Atar D, Borch-Johnsen K et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007; 14(Suppl 2): E1-E40.

8. Perk J, De Backer G, Gohlke H et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012; 33(13): 1635–1701.

9. Kotseva K, Wood D, De Backer G et al. EUROASPIRE Study Group. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil 2009; 16(2): 121–137.

10. Knopp RH. Drug treatment of lipid disorders. N Engl J Med 1999; 341(7): 498–511.

11. Ginsberg HN, Elam MB, Lovato LC et al. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010; 362(17): 1563–1574. Erratum in N Engl J Med 2010; 362(18): 1748.

12. Antons KA, Williams CD, Baker SK et al. Clinical perspectives of statin-induced rhabdomyolysis. Am J Med 2006; 119(5): 400–409.

13. Grundy SM, Vega GL, Yuan Z et al. Effectiveness and tolerability of simvastatin plus fenofibrate for combined hyperlipidemia (the SAFARI trial). Am J Cardiol 2005; 95(4): 462–468.

14. Durrington PN, Tuomilehto J, Hamann A et al. Rosuvastatin and fenofibrate alone and in combination in type 2 diabetes patients with combined hyperlipidemia. Diabetes Res Clin Pract 2004; 64(2): 137–151.

15. Cruz-Fernandez J, Bedarida G, Adgey J et al. Efficacy and safety of ezetimibe co-administered with ongoing atorvastatin therapy in achieving low-density lipoprotein goal in patients with hypercholesterolemia and coronary heart disease. Int J Clin Pract 2005; 59(6): 619–627.

16. Ballantyne C, Abate N, Yuan Z et al. Dose-comparison study of the combination of ezetimibe and simvastatin (Vytorin) versus atorvastatin in patients with hypercholesterolemia: the Vytorin Versus Atorvastatin (VYVA) study. Am Heart J 2005; 149(3): 464–473.

17. Kastelein JJ, Akdim F, Stroes ES et al. ENHANCE Investigators. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med 2008; 358(14): 1431–1443.

18. Blazing MA, Giugliano RP, Cannon CP et al. Evaluating cardiovascular event reduction with ezetimibe as an adjunct to simvastatin in 18,144 patients after acute coronary syndromes: final baseline characteristics of the IMPROVE-IT study population. Am Heart J 2014; 168(2): 205–212.

19. Blom DJ, Hala T, Bolognese M et al. DESCARTES Investigators. A 52-week placebo-controlled trial of evolocumab in hyperlipidemia. N Engl J Med 2014; 370(19): 1809–1819.

20. Newman C, Tsai J, Szarek M et al. Comparative safety of atorvastatin 80 mg versus 10 mg derived from analysis of 49 completed trials in 14,236 patients. Am J Cardiol 2006; 97(1): 61–67.

21. Sattar N, Preiss D, Murray HM et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; 375(9716): 735–742.

22. Preiss D, Seshasai SR, Welsh P et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA 2011; 305(24): 2556–2564.