title: Optimizing statin treatment for primary prevention of coronary artery disease.
abstract: BACKGROUND
  Although treating to lipid targets ("treat to target") is widely recommended for coronary artery disease (CAD) prevention, some have advocated administering fixed doses of statins based on a person's estimated net benefit ("tailored treatment").
  
  
  OBJECTIVE
  To examine how a tailored treatment approach to statin therapy compares with a treat-to-target approach.
  
  
  METHODS
  Simulated model of population-level effects of treat-to-target and tailored treatment approaches to statin therapy.
  
  
  METHODS
  Statin trials from 1994 to 2009 and nationally representative CAD risk factor data.
  
  
  METHODS
  U.S. persons aged 30 to 75 years with no history of myocardial infarction.
  
  
  METHODS
  Lifetime effects of 5 years of treatment.
  
  
  CONCLUSIONS
  Societal and patient.
  
  
  METHODS
  Tailored treatment based on a person's 5-year CAD risk (simvastatin, 40 mg, for 5% to 15% CAD risk and atorvastatin, 40 mg, for CAD risk >15%) versus treat-to-target approaches that escalate statin dose per National Cholesterol Education Program [NCEP] III guidelines (including an intensive approach that advances treatment whenever intensification is optional by NCEP III criteria).
  
  
  METHODS
  Quality-adjusted life-years (QALYs).
  
  
  RESULTS
  Compared with the standard NCEP III approach, the intensive NCEP III approach treated 15 million more persons and saved 570,000 more QALYs over 5 years. The tailored strategy treated a similar number of persons, as did the intensive NCEP III approach, but saved 500,000 more QALYs and treated fewer persons with high-dose statins.
  
  
  RESULTS
  No circumstances were found in which a treat-to-target approach was preferable to tailored treatment.
  
  
  CONCLUSIONS
  Model assumptions were based on available clinical data, which included few persons 75 years or older.
  
  
  CONCLUSIONS
  A tailored treatment strategy prevents more CAD events while treating fewer persons with high-dose statins than low-density lipoprotein cholesterol-based target approaches. Results were robust, even with assumptions favoring a treat-to-target approach.
  
  
  BACKGROUND
  Department of Veteran Affairs Health Services Research & Development Service's Quality Enhancement Research Initiative.
authors.affiliation: University of Michigan and Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. rhayward@umich.edu
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Hayward
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Donna M
authors.initials: DM
authors.lastname: Zulman
authors.forename: Justin W
authors.initials: JW
authors.lastname: Timbie
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vijan
mesh_terms: D000328:Adult; D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood; D002986:Clinical Trials as Topic; D003198:Computer Simulation; D003324:Coronary Artery Disease / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors