Statin-treated patients may have other lipid treatment needs
MedWire News: UK research suggests that many patients whose low-density lipoprotein (LDL) cholesterol remains elevated despite statin therapy could be at increased vascular risk through other lipid abnormalities.
The authors found that nearly half the patients with LDL-cholesterol levels above treatment targets also had abnormal levels of high-density lipoprotein (HDL) cholesterol or triglycerides.
These individuals had a 24% higher relative risk for a cardiovascular (CV) or cerebrovascular (CB) event than other statin-treated patients not at LDL-cholesterol goal.
The researchers say: “These findings support the conclusion that many patients receiving therapy with statins have further lipid-modifying treatment needs.”
Vasilisa Sazonov (Merck & Co. Inc, Whitehouse Station, New Jersey, USA) and colleagues studied 19,843 statin-treated patients aged at least 35 years on the UK General Practice Research Database.
Despite therapy, 6823 (34.4%) of these patients had elevated LDL-cholesterol (2.5 mmol/l; 96.68 mg/dl or more).
During a mean follow-up of 2.0 years, 715 (10.5%) of the patients with elevated LDL-cholesterol levels experienced CV/CB events.
These patients comprised a third of patients who experienced a vascular event, and the remaining two-thirds had LDL-cholesterol levels at or below goal levels.
Among statin-treated patients not at the LDL-cholesterol goal, those with low HDL-cholesterol (less than 1.0 mmol/l; 38.67 mg/dl in men and 1.2 mmol/l; 46.40 mg/dl in women) or high triglycerides (greater than 1.7 mmol/l; 150.57 mg/dl) had a hazard ratio (HR) for a vascular event of 1.24 compared with patients who did not have these other lipid abnormalities.
When analyzed separately, the HR for a vascular event was 1.21 in patients with elevated TG and LDL-cholesterol and 1.39 in those with elevated LDL-cholesterol and both HDL-cholesterol and TG abnormalities, compared with patients who had isolated LDL-cholesterol elevations.
Reporting in the journal Atherosclerosis, the researchers conclude: “These findings point to a potential ongoing need for more comprehensive lipid management and other interventions (eg, lifestyle modification) among patients who continued to experience elevated LDL-cholesterol despite statin therapy.”
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By Anita Wilkinson