Statins did not achieve the lower of low-density lipoprotein cholesterol (LDL-C) over a two-year study span in a general population initiated on statin therapy, according to new study results.
The prospective cohort study, published in Heart, included 165,411 primary care patients free of cardiovascular disease (CVD) prior to statin initiation from the UK Practice Research Datalink. Patients also had at least one pretreatment LDL-C and one post-treatment 24 months after statin initiation. The authors based their determination of a sub-optimal statin response by the current national guidelines (<40% reduction in baseline LDL-C levels within 24 months). The researchers used Cox proportional regression and competing-risks survival regression models to assess hazard ratios for CVD outcomes.
Half of patients on #statins fail to reach ‘healthy’ cholesterol level after 2 years of treatment with these drugs, reveals research published online in @Heart_BMJ today – read the full study https://t.co/iYT2K01R69 and linked editorial https://t.co/rD7tBtdfyp pic.twitter.com/rZzFnopXRt
— BMJ (@bmj_company) April 16, 2019
According to the study results, more than half (n=84,609; 51.2%) of the patients had sub-optimal response to statin therapy at 24 moths in terms of LDL-C reduction. The researchers reported 22,798 CVD events over 1,077,299 person-years of follow-up; of those, 12,142 were in sub-optimal responders and 10,656 in optimal responders. The hazard ratio for incident CVD was 1.17 (95% CI, 1.13 to 1.20) in sub-optimal responders compared to optimal responders, and 1.22 (95% CI, 1.19 to 1.25) after adjustment for age and untreated LDL-C at baseline. When competing risks were considered, it resulted in lower sub-hazard ratios for unadjusted and adjusted cumulative incidence function of CVD.
“Optimal lowering of LDL-C is not achieved within two 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,” the researchers concluded.
Talk With Your Doctor
The study results sparked public discussion about the widely prescribed class of cholesterol-targeting therapies.
“It may be that these people have been prescribed low dose or low potency statins, they are not taking the medication as prescribed, or they are not responding well to the type of statins that they have been prescribed,” Prof. Metin Avkiran, of the British Heart Foundation, told the Mirror in a media report about the results.
In another report, Prof. Avkiran also told the BBC that “statins are an important and proven treatment for lowering cholesterol and reducing the risk of a potentially fatal heart attack or stroke,” and that “you should continue to take [statins] regularly, as prescribed” despite the study results.
“If you have any concerns you should discuss your medication with your general practitioner,” Prof. Avkiran said. “There are now other drugs available to help lower cholesterol levels, and it may be that another type of medication will be an effective addition or alternative for you.”
More than half of patients taking statins don't achieve an adequate LDL cholesterol (and have a higher event rate): prospective study of 165K patientshttps://t.co/dhaRntkee8@Heart_BMJ @StephenFWeng @rkakyea @UniofNottingham pic.twitter.com/9TOdZxIdSO
— Eric Topol (@EricTopol) April 16, 2019
Sub-optimal cholesterol response to initiation of statins and future risk of cardiovascular disease https://t.co/V81QzB5U7w
— Kate Downes (@Kate_Sci) April 16, 2019
Well done @rkakyea for leading this analysis for our new paper! Full day of media ahead! Stay tuned
— Stephen Weng (@StephenFWeng) April 16, 2019
Sub-optimal #cholesterol response to initiation of #statins and future risk of #cardiovascular disease | Prospective cohort study of 165 411 primary care patients, from the UK who were free of CVD before statin initiation finds https://t.co/peQpnITxp5
— EMAS (@emas_online) April 16, 2019
As a #pharmacist I’m listening to the @BBCr4today reporting @StephenFWeng @Heart_BMJ #statin paper with interest & wondering if statins didn’t work in 50% patients because the dose wasn’t being adjusted based on #cholesterol tests
— Kathryn Murray (@kmmurray97) April 16, 2019
— Michael Sagner, MD (@MichaelSagnerMD) April 16, 2019
— Miguel Canales (@DrMCanales) April 16, 2019