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At the heart of general practice since 1960

Cholesterol study ranks effectiveness of statins

A key Government adviser has recommended GPs use one of two statins for first-line treatment of coronary heart disease after results from an independent head-to-head cholesterol reduction study ranked atorvastatin as the most effective.

Study lead Professor Mike Pringle, a Department of Health adviser on the diabetes national service framework, said practices involved in the study were switching patients to atorvastatin to take the results into account.

Professor Pringle, professor of general practice at the

University of Nottingham and former chair of the RCGP, said: 'It does appear either simvastatin or atorvastatin are to be recommended.'

But a GP adviser to the CHD national service framework urged caution when putting the findings into practice.

Dr John Pittard, a member of the external reference group for the framework and a GP in Staines, Middlesex, said: 'I can't see the logic of changing patients over. In the short-term there's going to be a £10-a-month advantage in using atorvastatin but that's going to disappear in 2003 when simvastatin goes off-patent.'

The study, reported at a cardiovascular risk conference in London earlier this month, examined cholesterol levels in 2,469 patients from 17 general practices in the Trent region.

Some 65 per cent of patients had ischaemic heart disease, 48 per cent hypertension, 22 per cent diabetes and 12 per cent previous stroke. All patients in the study had previously been put on either a statin or a fibrate.

The results showed atorvastatin was the most effective, reducing cholesterol by an

average of 30 per cent between first prescription and most recent cholesterol check compared with 24 per cent for fluvastatin (see box).

More than half ­ 55 per cent ­ of patients in the study reached the CHD national service framework cholesterol target of 5mmol/l for patients with CHD or a cardiac event risk of greater than 30 per cent over 10 years.

The study, which has been submitted to the BMJ, also showed patients on atorvastatin were 15 per cent more likely to achieve the target compared with patients on simvastatin.

How statins compared in new study

Statin Average Odds ratio

percentage for reducing

reduction in cholesterol

cholesterol to Ã5mmol/l

Atorvastatin 30 1.15

Simvastatin 28 1.00

Pravastatin 25 0.60

Fluvastatin 24 0.45

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