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Lowest statin dose counterproductive

For the secondary prevention of CHD the clinical aim is to lower serum cholesterol to below 5.0mmol/l. When the lowest dose of statins is used to initiate medication, targets may not be achieved.

Many patients remain at a higher risk of a secondary event, mainly due to our reluctance to increase statin dose or tendency to accept a cholesterol reduction that is still above targets.We investigated the effect of doubling the dose of statins for all patients with cholesterol higher than 5.0mmol/l on the secondary prevention register of a two-person inner-city practice.

Twenty patients had above-target cholesterol levels at their original statin dose (mean 5.96mmol/l, SD 0.91, range 9.2-5.0).

Four months after their dose was doubled, data from 19 subjects was available. Sixteen had a statistically significant reduction (p<0.05, mean="" decrease="" 1.18mmol/l,="" sd="" 0.99,="" range="" 3.4="" reduction="" –="" 0.3="" increase),="" with="" nine="" reducing="" to="" below="" target.="" after="" a="" further="" four="" months="" on="" double="" their="" original="" dosage="" these="" nine="" subjects="" remained="" below="">

We endeavoured to take into account factors such as accuracy and consistency of blood sampling, length of periods of fasting before sampling, laboratory testing consistency and patients' compliance in taking their medication. No side-effects were noted or reported and all measurements and samples were taken on a blind basis. With the caveat that this was a small sample tested in one specific location, as the cost differential is minimal, we recommend that this strategy be explored by other GPs for comparable patients.

Dr Nassif Abd-Mariam

Dr Alasdair MacSween

Mr Philip Booth

Hull

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