06 May Not All Patients Require High Intensity Statins To Achieve LDL Control
MedicalResearch.com Interview with:
Dr. Martha Rumore
Martha M. Rumore, PharmD, JD, MS, LLM, FAPhA
Associate Professor, Social, Behavioral & Administrative Pharmacy
Touro College of Pharmacy
New York, NY 10027
& Of Counsel Sorell, Lenna, & Schmidt, LLP
MedicalResearch.com: What is the background for this study?
Dr. Rumore: The management of lipid therapy is only one component that affects overall cardiovascular outcomes.This study is one of the first to look at the benefits of dose titration versus intensity-based statin therapy. To evaluate whether patients titrated on statin therapy using ATPIII algorithm with an LDL goal of <100mg/dL also met the 2013 ACC/AHA Guideline for Management of Blood Cholesterol goal of ≥40% LDL reduction from baseline compared to inpatients initiated on high-moderate intensity statin (HIS). Other objectives included comparison of algorithms to lower LDL ≥40%, final dose, adverse drug events (ADEs), clinic visits to goal, and cardiovascular event occurrence.
MedicalResearch.com: What are the main findings?
Dr. Rumore: 981 patients were included- 43% were titrated and 57% achieved LDL<100; 38% achieved both LDL <100mg/dL and LDL ≥40% reduction; 58% received HIS and 53% achieved LDL <100; 43% achieved both LDL <100mg/dL and LDL ≥40% reduction.
Initiating patients on High Intensity statins was not more effective than dose titration in achieving <100mg/dL and ≥40% LDL reduction;X2=0.006,N=159,p=0.938. A 50% LDL reduction in patients that also achieved an LDL <100 was 54% and 48%, in titration and HIS groups, respectively; X2=0.611,N=159,p=0.434. The titration group required an average of 4.3 clinic visits to achieve goal, compared to 3.1 visits for HIS; p=0.309; 95% CI(-1.36,1.06).
MedicalResearch.com: What should readers take away from your report?
Dr. Rumore: ·
- Not all patients require a high-moderate intensity statin to achieve LDL < 100.
- Not all patients require a 40-50% reduction to achieve a LDL < 100.
- Not all MHIG achieve either a LDL < 100 or 50% reduction.
- It is uncertain whether ACA/AHA guidelines provide benefits over ATP III.
- ADEs were more likely in the titration group compared to the MHIG.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Most of our patients were on simvastatin because this was the preferred VA formulary agent. Newer/more potent agents are less lipophilic and have less drug interactions and should be studied as well. Other populations should be studied as all our patients were male.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Rumore: Not all patients require High Intensity statins, nor do all patients require a 40-50% reduction to achieve LDL <100mg/dL, and not all HIS patients achieve either LDL <100mg/dL or 50% reduction. It remains uncertain whether the new ACA/AHA Guidelines provide additional benefit compared to previous ATPIII guidelines.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
Touro College Research Day abstract discussing:
High Intensity Statins are No More Effective than Regular Statin Therapy
Organized by the Touro Research Collaborative, Touro College Research Day held on Tuesday, May 3, at the Touro College of Osteopathic Medicine and the Touro College of Pharmacy campus in Harlem
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Last Updated on May 6, 2016 by Marie Benz MD FAAD