Efficacy of atorvastatin in treating high risk patients to reach low density lipoprotein-cholesterol goals: the Treat to Target (TTT-Israel) Study.
BACKGROUND
Hyperlipidemia is a major risk factor for coronary heart disease. Reducing low density lipoprotein-cholesterol can significantly reduce the risk of CHD, but many patients fail to reach the target LDL-C goals due to low doses of statins or low compliance.


OBJECTIVE
To treat high risk patients with atorvastatin in order to reach LDL-C goals (either primary or secondary prevention) of the Israel Atherosclerosis Society.


METHODS
In this open-label study of 3,276 patients (1,698 of whom were males, 52%), atorvastatin 10 mg was given as a first dose, with follow-up and adjustment of the dose every 6 weeks. While 1,670 patients did not receive prior hypolipidemic treatment, 1,606 were treated with other statins, fibrates or the combination of both.


RESULTS
After 6 weeks of treatment, 70% of the patients who did not receive prior hypolipidemic medications and who needed primary prevention reached target LDL-C levels. Interestingly, a similar number of patients who received prior hypolipidemic treatment (other statins, fibrates or both) and who did not reach the LDL-C treatment goals reached the LDL-C goals for primary prevention with atorvastatin. Only 34% of all patients who needed secondary prevention reached the ISA LDL-C target of 100 mg/dl. Atorvastatin proved to be completely safe, only two patients had creatine kinase elevation above 500 U/L, and another six had mild CK elevation (< 500 U/L). None of the patients had clinical myopathy, and only one had to be withdrawn from the study.


CONCLUSIONS
Atorvastatin is a safe and effective drug that enables most patients requiring primary prevention to reach LDL-C goal levels, even with a low dose of 10 mg. Patients in need of secondary prevention usually require higher doses of statins.
Leibovitz
Eyal
E
Department of Internal Medicine A and Institute of Physiological Hygiene, Wolfson Medical Center, Holon, Israel.
Harats
Dror
D
Gavish
Dov
D
D000328:Adult; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000069059:Atorvastatin; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000097:blood* / Q000187:drug effects*; D003327:Coronary Disease / Q000517:prevention & control; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy*; D007557:Israel; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention; D011446:Prospective Studies; D011758:Pyrroles / Q000008:administration & dosage / Q000627:therapeutic use*; D012307:Risk Factors; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin