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31-08-2011 | Cardiometabolic | Article

Maximal statin dose more effective than titrated approach at lowering cholesterol


Free abstract

MedWire News: Maximal dose statin therapy is associated with higher efficacy and greater prevention of pathologic changes in graft coronary arteries after heart transplantation than titrated dosing, a study suggests.

However, both approaches are just as effective as each other at achieving a low-density lipoprotein (LDL) cholesterol level of less than 100 mg/dl 12 months after transplantation, add Luciano Potena and co-authors from the University of Bologna in Italy.

"By using a maximum statin dose approach, achievement of early reduction of cholesterol levels, in addition to possible lipid-independent effects, may confer a greater protection against cardiac allograft vasculopathy (CAV) development," they write.

The study, published in the Journal of Heart and Lung Transplantation, involved 52 patients who were randomly allocated, in a 1:1 ratio, to treatment with an early maximal dose of fluvastatin 80 mg/day or fluvastatin 20 mg/day subsequently titrated to achieve a LDL level lower than 100 mg/dl. Treatment occurred between 3 to 5 weeks after heart transplantation.

The results showed that the efficacy in achieving the LDL target at 12 months after transplantation was comparable in both groups, at 50% in the early maximal dosing arm and 54% in the titrated dosing arm.

Patients who received the maximal dose had a significantly lower average LDL level than those in the titrated dose arm, at 93 mg/dl versus 198 mg/dl.

Patients who had an average LDL concentration that was lower than 100 mg/dl at baseline, and who received the maximal statin dose had an unchanged average LDL cholesterol level after 12 months. However, the average LDL level increased significantly from 85 mg/dl to 103 mg/dl, in those who received the titrated dose.

In addition, a higher proportion of titrated dose patients developed an increase in maximal intimal thickness of more than 0.5 mm, at 12.5%, than the maximal dose patients, at 5%.

Furthermore, intimal volume increased in the titrated dose patients, but not in the maximal dose patients, who showed a higher prevalence of negative remodeling.

"This study has shown suggestive evidence that a titrated-dosing approach of fluvastatin is as effective as a maximal early dose in achieving target LDL levels at 1 year after transplant," report Potena et al.

"However, the early maximal-dosing approach seems to provide additional benefit by allowing a more rapid lipid-lowering effect and a possible delay in the development of coronary intimal hyperplasia, the key feature of early CAV," they conclude.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Piriya Mahendra