Statin treatment should be based on 'risk and not cholesterol levels'
By Yvette Martyn
Tailoring statin treatment to the level of coronary risk is more effective at preventing coronary events than treating to a particular cholesterol target, a US study has found.
The researchers used a simulation model to predict the number of coronary artery events in US adults aged 30 to 75 years without any history of heart attack. They found prescribing statins using a treatment strategy tailored to a patient's coronary risk prevented more events and patients required less high-dose statins.
The tailored treatment involved prescribing simvastatin, 40mg for patients with a 5-15% CAD risk over five years and atorvastatin, 40mg for patients with a risk greater than 15%. Whilst the treat-to-target approach increased the dose of simvastatin and atorvastatin based on levels of LDL-cholesterol.
The tailored treatment was found to be superior to the treat-to-target approach, saving 10 more QALYs per 1000 persons treated. Projected to the US population 4.5 million fewer would receive a high dose-potency statin compared to an intensive treat-to-target strategy.
Study leader, Professor Rodney Hayward, professor of internal medicine at the University of Michigan, USA, said treat-to-target strategies place more weight on LDL-cholesterol than other predictors of treatment benefit and ignore other highly relevant information.
He said: 'We found that under a wide range of assumptions and circumstances, a simple tailored treatment strategy for statin therapy for persons aged 30 to 75 years was more efficient and prevented substantially more CAD morbidity and mortality than any of the currently recommended treat-to-target approaches.'
Ann Intern Med 2010; 152: 69-77Treatment with statins - such as simvastatin - should be based on risk levels say researchers