Effectiveness of lipid-lowering therapy with statins for secondary prevention of atherosclerosis--guidelines vs. reality.
BACKGROUND
The aim of the study was to analyze the effectiveness of lipid-lowering therapy and therapeutic decisions made by physicians for patients not achieving LDL targets.


METHODS
11,768 patients undergoing therapy with statins for secondary prevention of atherosclerosis participated in a two-visit survey. In subjects not achieving the LDL-target (< 100 mg/dl), further therapeutic decisions made by physicians were recorded.


RESULTS
Initially the LDL-target was achieved by 7.8% of patients on simvastatin and by 18.0% on atorvastatin, of which 20.8% were treated with at least a 40 mg dose. The most common changes in therapy to improve effectiveness was substituting simvastatin for another statin (75.2%, usually atorvastatin), or increasing atorvastatin dosage (59.8%). Intensification of a low fat diet and weight reduction were more frequently recommended in treatment with atorvastatin than with simvastatin (59.8% vs. 55.9%, p < 0.001). After enhanced therapy, the LDL-target was achieved by 27.8% on simvastatin and by 35.0% on atorvastatin (p < 0.001). In those with LDL levels remaining above the target, substitution of simvastatin with atorvastatin (49.9%), or the increase of atorvastatin dose (41.4%) was recommended. As previously, life-style counseling was more frequent in patients on atorvastatin (66.1% vs. 45.7% p < 0.001).


CONCLUSIONS
1. The use of low dose statins and noncompliance with behavioral modification guidelines are responsible for the low levels of effectiveness found with lipid-lowering therapies. 2. Physicians prefer substitution of less effective statins over the increase of dose in patients not achieving LDL targets. 3. Life-style changes are under-prescribed by physicians and under-implemented by their patients.
Pathophysiology Unit, Department of Pathophysiology, Medical University of Silesia, Katowice, Medyków 18, PL 40-752 Katowice, Poland.
Maria
M
Bożentowicz-Wikarek
Piotr
P
Kocełak
Mike
M
Smertka
Magdalena
M
Olszanecka-Glinianowicz
Jerzy
J
Chudek
D050197:Atherosclerosis / Q000097:blood / Q000178:diet therapy / Q000453:epidemiology / Q000517:prevention & control*; D000069059:Atorvastatin; D008078:Cholesterol, LDL / Q000097:blood*; D003657:Decision Making; D018752:Diet, Fat-Restricted; D004038:Diet, Reducing; D004305:Dose-Response Relationship, Drug; D005260:Female; D006306:Health Surveys; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011044:Poland; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011758:Pyrroles / Q000008:administration & dosage / Q000627:therapeutic use*; D012424:Rural Population; D055502:Secondary Prevention / Q000379:methods*; D019821:Simvastatin / Q000008:administration & dosage / Q000627:therapeutic use*; D014505:Urban Population
D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin