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Half of patients on statins have ‘sub-optimal’ response to treatment

Half of patients taking statins had a ‘sub-optimal’ response to the treatment, a study has found, leading to calls for GPs to tailor statin regimens to individual patients.

Patients who didn’t achieve NICE-recommended reductions in LDL-C were more likely than those who did to suffer cardiovascular events, the researchers found.

The study, published in Heart, was carried out by primary care researchers at the University of Nottingham and looked at just over 165,400 primary care records for patients who were started on a statin between 1990 and 2016.

They found that 51% of patients had a sub-optimal response to statin therapy after two years on treatment, meaning that they hadn’t achieved a greater than 40% reduction in LDL-C levels.

When figures were adjusted for age, sub-optimal responders were 22% more likely to experience a CVD-related event, such as coronary artery disease, stroke or TIA, or peripheral vascular disease than optimal responders.

Sub-optimal responders were also 25% more likely to die of CVD-related causes.

The authors said that the findings could be explained by factors like genetics or levels of adherence to statin medication.

They said in the paper: ‘Currently, there is no management strategy in clinical practice which takes into account patient variations in LDL-C response, and no guidelines for predictive screening before commencement of statin therapy. Validated clinical decision tools which can predict cholesterol response to statins, or to non-statin drugs, with interventions to help clinicians to tailor and optimise statin treatments for individual patients are needed.’

Professor Helen Stokes-Lampard, chair of the RCGP commented: ‘When we prescribe medication, we have to rely on patients to make sure that they take it, both at the recommended dose and for the duration of time that we think will benefit them most.

‘There is a substantial body of research showing that statins are safe and effective drugs for most people, and can reduce the risk of heart attacks and stroke, when prescribed appropriately – but controversy remains around their widespread use and their potential side-effects.

‘There are complex reasons why patients choose not to take their prescribed medication, and mixed messaging around statins could be one of these.’

‘We would encourage anyone who is on regular medication to attend their scheduled medication reviews and to raise any queries or concerns they might have. But given the widespread GP shortages and intense workload pressures that we currently have in general practice, it’s hard to know what more we can do to encourage greater compliance with medications that have been recommended in good faith.’

Professor Jamie Waterall, national lead for cardiovascular disease prevention at Public Health England, said: ’Current recommendations on statin use are based on robust and extensive evidence and it is widely accepted that the benefits of statins far outweigh any possible adverse effects.

’It’s important that statins are taken as prescribed and optimising their use in line with NICE guidance is vital to help prevent thousands of avoidable heart attacks and strokes.’

The findings come as Public Health England launched a campaign in February to increase the proportion of 40-74 year old patients receiving blood pressure and cholesterol checks to 75% by 2029. The campaign also wants to see 45% of patients at high CVD risk treated with statins by 2029 – up from the current proportion of 35%.



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