Lower achievement rates of targeted low-density lipoprotein cholesterol (LDL-C) levels were observed in high-risk dyslipidemia patients unable to take or not taking statins, a recent study found. Researchers investigated 2,527,405 dyslipidemia patients with atherosclerotic cardiovascular disease (ASCVD) between April 2008 and September 2017. Definition 1 included statin discontinuation or down-titration with non-statin lipid modifying therapy (LMT) prescription, rhabdomyolysis or muscle-related symptoms with statin down-titration or discontinuation, or prescription for ≥3 statin types. Definition 2 included all components of Definition 1 in addition to statin down-titration or discontinuation for any reason. Patients never given statins but who started non-statin LMT were considered as Definition 3. Among the findings:
- Among 54,296 patients with statin prescription, 2.32% and 48.38% patients were identified as Definition 1 and 2, respectively.
- 13.16% of patients were identified as Definition 3.
- The achievement rate of target LDL-C level was lower in patients meeting each definition than not satisfying each definition.
- Suboptimal management of LDL-C is directly associated with residual CV risk,
Kajinami K, Ozaki A, Tajima Y, Yamashita S, Arai H, Teramoto T. Real-world data to identify hypercholesterolemia patients on suboptimal statin therapy. [Published online ahead of print October 26, 2018]. J Atheroscler Thromb. doi:10.5551/jat.46201.
The 2018 AHA/ACC lipid-lowering guidelines recommended statins as first line therapy for ASCVD risk reduction in at risk patients. High dose statins achieving a 50% or greater reduction in LDL-C are recommended for high risk individuals. Unfortunately, many patients are unable to tolerate optimal statin therapy frequently due to muscle symptoms. This study identified over 48% of patients with a statin prescription either discontinued or down-titrated statin therapy for any reason. This suggests that potentially half of statin-treated patients may not achieve optimal LDL-C targets and not obtain the full benefit of lipid lowering. Strategies to improve statin compliance and tolerance are needed. —Matthew Sorrentino, MD