Half of people on prescription statins do not reach their cholesterol goals, study finds

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The researchers used data submitted to the UK Clinical Practice Research Datalink by 681 family physicians. The study group consisted of 165,411 people who had a statin prescribed between 1990 and 2016 and who had not been treated for heart disease or stroke before prescribing.

They defined an "appropriate" response to statin therapy as a 40% or greater reduction in LDL or "bad" cholesterol, as recommended by the UK's National Institute for Health and Care Excellence.

According to the study, less than half of those enrolled during the 26-year study period – 48.8% – achieved their target cholesterol levels after two years, and a little more half – 51.2% – did not achieve this goal, published Monday in the journal Heart.

After taking into account age differences and underlying medical conditions, researchers found that people who did not reduce their LDL cholesterol levels were 22% more likely to develop cardiovascular disease than those who did not reduce their LDL cholesterol levels. l & # 39; lowered.

Statins reduce LDL cholesterol or low density lipoproteins, which decreases the risk of heart attack and stroke. In the United States, the American Heart Association and the American College of Cardiology recommend that physicians use a 10-year risk calculator to determine which patients may benefit from such treatment.
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According to US Centers for Disease Control and Prevention, more than 78 million Americans, just over a third of all adults, are eligible for statin therapy or taking a statin. In the UK, more than 7 million adults take these drugs, according to the British Heart Foundation.

The number of Americans who do not reach target cholesterol levels after starting to use a statin is probably similar to the results of the study, explained Dr. David Fischman, professor of medicine and co-director of the Cardiac Catheterization Lab at Thomas Jefferson University Hospital. not involved in the study.

"Taking care of patients, treating them with statins, it's a job.It's a lot of work.This is not easy.It's a time commitment to do it right, "said Fischman. "When you start taking a cholesterol medication, you're supposed to check your cholesterol level within four to 12 weeks, and then make adjustments, which highlights the importance of doing it."

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In addition to the amount of work and commitment required to optimize cholesterol levels, the authors explain that genetic factors and differences in adherence to prescribed dosing regimens may explain some of the variations in the response to statin prescriptions and they call for a "personalized" medicine.

"Currently, there is no management strategy in clinical practice that takes into account variations in patients [low density cholesterol] and recommendations for predictive screening before starting statin therapy, "said the researchers.

In an editorial published alongside the study in Heart, Dr. Márcio Bittencourt, a cardiologist at the University Hospital of São Paulo, Brazil, explains that prescribing practices of physicians may also explain some of the differences seen in the research. Those who achieve their cholesterol goals are more likely to be prescribed stronger statins, probably because the group has also started with higher cholesterol levels, he said.

Research has several limitations. As an observational study, it can not establish cause and effect. The exact dosage of statins prescribed and the observation of prescriptions by patients did not come within the scope of the research.

"For me, the message is that we have to do a good job, we have to follow, not just the doctor, but the patient as well," said Fischman. "Because if we do not do it, [patients who don’t reach target cholesterol levels] are not going to do as well. "

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