Limitations of statin monotherapy for the treatment of dyslipidemia: a projection based on the Canadian lipid study--observational.
OBJECTIVE
Several randomized controlled trials indicate that a low density lipoprotein cholesterol (LDL-C) target <2.0 mmol/L is appropriate for individuals at high risk of coronary artery disease (CAD). Recently released Canadian lipid management guidelines (2006) have incorporated this evidence into their recommendations. A cross-sectional study of patients treated with statins for at least 8 weeks (CALIPSO) was used as a basis to project the ability of statin monotherapy in getting high CAD-risk patients to an LDL-C level <2.0 mmol/L.


METHODS
The analysis was restricted to CALIPSO patients on statin monotherapy who were at high CAD-risk (including patients with established CAD). Assuming all patients could have their statin titrated up to the maximum dose, the proportion of patients that would reach an LDL-C level of <2.0 mmol/L was projected. To do this, the additional LDL-C reduction patients would achieve with maximal titration of their statin was estimated based on a meta-analysis of clinical trials evaluating LDL-C responses to various statin regimens, and applied to patients' current LDL-C level.


RESULTS
A total of 1795 high CAD-risk patients treated with statin monotherapy were included in the analysis, of whom 69.8% had an LDL-C > or =2.0 mmol/L. Depending on the statin that was used, it was projected that between 28.2% and 62.7% of high CAD-risk patients would not attain an LDL-C of <2.0 mmol/L following statin titration to maximum dose.


CONCLUSIONS
Although the accuracy of our projections may be limited by the application of clinical trials data to an external sample of patients, our results suggest that for 38% of patients at high CAD-risk, titration of statin monotherapy will not be sufficient to achieve an LDL-C target of <2.0 mmol/L. For these patients, additional treatment approaches may be needed to further reduce the risk of coronary events.
Sénécal
Martin
M
Health economics and outcomes research, Merck Frosst Canada Ltd., Montreal, Canada. martin_senecal@merck.com
Fodor
George
G
Gagné
Claude
C
Genest
Jacques
J
Lavoie
Marc-André
MA
McPherson
Ruth
R
Marentette
Michael
M
Sebaldt
Rolf J
RJ
D000368:Aged; D002170:Canada; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000150:complications; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors