title: Achievement of 2011 European low-density lipoprotein cholesterol (LDL-C) goals of either <70 mg/dl or ≥ 50% reduction in high-risk patients: results from VOYAGER.
abstract: OBJECTIVE
  Guidelines published in 2011 by the European Atherosclerosis Society and the European Society of Cardiology recommend a goal of either low-density lipoprotein cholesterol (LDL-C) <70 mg/dl (~1.8 mmol/l) or ≥ 50% reduction in LDL-C for patients at very high cardiovascular risk. The aim of this study was to determine the percentage of high-risk patients from the VOYAGER individual patient data meta-analysis treated with rosuvastatin 10-40 mg, atorvastatin 10-80 mg or simvastatin 10-80 mg who achieved this goal.
  
  
  METHODS
  We analysed 25,075 patient exposures from high-risk patients. Paired comparisons were made between each rosuvastatin dose and an equal or higher dose of either atorvastatin or simvastatin, with a series of meta-analyses that included only randomised studies that directly compared rosuvastatin and its comparator treatments.
  
  
  RESULTS
  As statin dose increased, higher percentages of patients achieved LDL-C <70 mg/dl or ≥ 50% LDL-C reduction. A greater percentage achieved this goal with rosuvastatin 10-40 mg (43.8-79.0%) than with equal or double milligram doses of atorvastatin (16.1-65.2%) or simvastatin (0-39.7%). Paired comparisons showed statistically significant differences for: rosuvastatin 10 mg vs. atorvastatin 10-20 mg and simvastatin 10-20 mg; rosuvastatin 20 mg vs. atorvastatin 20-40 mg and simvastatin 20-80 mg; and rosuvastatin 40 mg vs. atorvastatin 40-80 mg and simvastatin 40-80 mg (all p < 0.001).
  
  
  CONCLUSIONS
  These data from VOYAGER highlight the importance of an effective statin at an appropriate dose to achieve treatment goals for LDL-C in patients with very high cardiovascular risk.
authors.affiliation: AstraZeneca, Mölndal, Sweden. Bjorn.W.Karlson@astrazeneca.com
authors.forename: Björn W
authors.initials: BW
authors.lastname: Karlson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
authors.forename: Pia
authors.initials: P
authors.lastname: Lundman
authors.forename: Mike K
authors.initials: MK
authors.lastname: Palmer
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Barter
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D000069059:Atorvastatin; D008078:Cholesterol, LDL / Q000097:blood*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use*; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000627:therapeutic use*; D011758:Pyrroles / Q000627:therapeutic use; D012307:Risk Factors; D040242:Risk Reduction Behavior; D000068718:Rosuvastatin Calcium; D019821:Simvastatin / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use*
chemical_list: D008078:Cholesterol, LDL; D005464:Fluorobenzenes; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin; D019821:Simvastatin