Considerable individual variability in response to statin treatment
Karlson BW, Wiklund O, Palmer MK, et al.
Variability of low-density lipoprotein cholesterol response with different doses of atorvastatin, rosuvastatin, and simvastatin: results from VOYAGER
Eur Heart J Cardiovasc Pharmacother 2016; published online ahead of print
BackgroundRecent ACC/AHA guidelines recommend the following :
- all patients at high atherosclerotic cardiovascular disease (ASCVD) risk should be treated with high-intensity statins, defined as atorvastatin 40 and 80 mg and rosuvastatin 20 and 40 mg: expected LDL-C decrease 50% or more
- all patients at moderate ASCVD risk, those aged >75 years, or those with high-intensity statin-intolerance should be treated with moderate-intensity statins, such as atorvastatin 10–20 mg, rosuvastatin 5–10 mg, and simvastatin 20–40 mg: expected LDL-C decrease 30%-50%
In this study, the variability in LDL-C reduction following treatment with different statins at different doses was evaluated, using the VOYAGER (an indiVidual patient data meta-analysis Of statin therapY in At risk Groups: Effects of Rosuvastatin, atorvastatin and simvastatin) meta-analysis database, in which 32,258 patients were treated with atorvastatin 10–80 mg, rosuvastatin 5–40 mg or simvastatin 10–80 mg [4,5].
Main resultsPercentage LDL-C reduction (standard deviation [SD]):
- for all statins and doses: SD: 12.8% - 17.9%
- lowest mean LDL-C reduction: 28.4% (13.8) with simvastatin 10 mg
- highest mean LDL-C reduction: 55.5% (14.8) with rosuvastatin 40 mg
- with atorvastatin 10–80 mg: mean reduction: 35.7% (16.0) - 49.2% (17.3)
- with rosuvastatin 5–40 mg: mean reduction: 41.4% (12.8) - 55.5% (14.8)
- with simvastatin 10–80 mg: mean reduction: 28.4% (13.8) - 45.7% (13.1)
- 10.2% of patients failed to achieve a 15% reduction in LDL-C
- 27.2% failed to achieve a 30% reduction
- 85.9% failed to achieve a 50% reduction
- 4.3% of patients failed to achieve a 15% reduction in LDL-C
- 12.8% failed to achieve a 30% reduction
- 67.7% failed to achieve a 50% reduction
- 2.8% of patients failed to achieve a 15% reduction in LDL-C
- 7.6% failed to achieve a 30% reduction
- 52.6% failed to achieve a 50% reduction
- 4.7% of patients failed to achieve a 15% reduction in LDL-C
- 11.3% failed to achieve a 30% reduction
- 42.5% failed to achieve a 50% reduction
When simvastatin was given, the proportions failing to achieve a reduction in LDL-C of 15%, 30% and 50% were, respectively, 12.7%, 53.3% and 98.8%, at the 10 mg dose, 10.7%, 32.8% and 90.2% at the 20 mg dose, 4.4%, 17.7% and 78.6% at the 40 mg dose and 4.2%, 9.0% and 56.9% at the 80 mg dose.
The percentage of patients experiencing a suboptimal response (<30% reduction in LDL-C) ranged from 2.8% to 53.3%.
ConclusionThere is considerable individual variation in the LDL-C reduction at all doses of simvastatin, atorvastatin and rosuvastatin. This individual variability is important to consider in daily clinical practice, especially when interpreting the ACC/AHA guideline recommendations, in order to amend treatment as appropriate.
Find this article online at http://ehjcvp.oxfordjournals.org/content/early/2016/03/29/ehjcvp.pvw006.abstract?papetoc
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