Cross sectional survey of effectiveness of lipid lowering drugs in reducing serum cholesterol concentration in patients in 17 general practices.
OBJECTIVE
To compare the effectiveness of lipid lowering drugs in lowering serum cholesterol concentrations.


METHODS
Cross sectional study.


METHODS
17 practices within 17 primary care groups in Trent region, United Kingdom.


METHODS
Patients aged 35 years or over taking lipid lowering drugs and with at least two serum cholesterol concentrations recorded on computer.


METHODS
Proportion of patients achieving serum cholesterol concentration of < or =5 mmol/l and mean percentage reduction in serum cholesterol concentration.


RESULTS
1353 of 2469 (54.8%) patients receiving lipid lowering treatment had a last recorded serum cholesterol concentration of < or =5 mmol/l. Significantly more patients taking statins achieved the target value for serum cholesterol (5 mmol/l) than those taking fibrates (1307 (57%) v 46 (26%); P<0.0001). Atorvastatin and simvastatin were the most effective drugs in achieving the target. Significant differences were found between lipid lowering drugs for the pretreatment serum cholesterol concentration, the most recent cholesterol concentration, and the associated percentage reduction. Atorvastatin and simvastatin achieved the greatest percentage reduction in serum cholesterol concentrations (30.1%, 95% confidence interval 28.8% to 31.4%, and 28.0%, 26.7% to 29.3%, respectively). Although the mean serum cholesterol concentrations in this unselected population tended to be higher than those in clinical trials, the percentage reduction was consistent with the trials.


CONCLUSIONS
The ability of individual statins to lower serum cholesterol concentration varied, with atorvastatin and simvastatin being the most effective. The percentage reductions agreed with those of randomised controlled trials indicating likely benefits in unselected patients in primary care. As the initial serum cholesterol concentrations were higher than those in randomised controlled trials, target serum cholesterol values of < or =5 mmol/l may be unrealistic even for patients taking the most efficacious drugs. Also, the higher initial levels could mean that the absolute reduction in cardiovascular risk in primary care patients is greater than thought.
Hippisley-Cox
Julia
J
Division of General Practice, Nottingham University, Nottingham NG7 2RD. julia.hippisley-cox@nottingham.ac.uk
Cater
Ruth
R
Pringle
Mike
M
Coupland
Carol
C
D000328:Adult; D000368:Aged; D002784:Cholesterol / Q000097:blood; D003430:Cross-Sectional Studies; D005194:Family Practice; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000097:blood / Q000517:prevention & control*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008875:Middle Aged; D016017:Odds Ratio; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D002784:Cholesterol