Nottingham, UK—Despite widespread use of statins in primary care, half of patients prescribed the drugs actually don’t reach optimal cholesterol levels after 2 years of treatment.

That’s according to research published in the journal Heart. Guidelines in the United Kingdom and the United States specify statin treatment targets. For example, in the UK, where this research was based, the National Institute for Health and Care Excellence stipulates a reduction of 40% or more in LDL cholesterol.

The University of Nottingham–led study team sought to determine how often those goals were met and how that affected patients’ risk of cardiovascular disease (CVD).

To do that, the researchers conducted a prospective cohort study of 165,411 primary care patients, from the UK Clinical Practice Research Datalink, who were free of CVD before statin initiation, and had at least one pretreatment LDL-C within 12 months before, and one posttreatment LDL-C within 24 months after statin initiation.

The study points out that, based on current national guidelines, a less-than-40% reduction in baseline LDL-C within 24 months is classified as a suboptimal statin response.

Results showed that 51.2%, representing nearly 85,000 patients, had a suboptimal LDL-C response to initiated statin therapy within the 2-year period.

Researchers report that, during 1.07 million person-years of follow-up (median follow-up 6.2 years), 22,798 CVD events occurred—12,142 in suboptimal responders and 10,656 in optimal responders.

Comparing suboptimal responders to optimal responders, study authors calculated hazard ratios (HRs) for incident CVD of 1.17 (95% CI, 1.13-1.20) and 1.22 (95% CI, 1.19-1.25) after adjusting for age and baseline untreated LDL-C.

Researchers note that considering competing risks resulted in lower but similar sub-HRs for both unadjusted (1.13, 95% CI, 1.10-1.16) and adjusted (1.19, 95% CI, 1.16-1.23) cumulative incidence function of CVD.

“Optimal lowering of LDL-C is not achieved within two years in over half of patients in the general population initiated on statin therapy, and these patients will experience significantly increased risk of future CVD,” study authors concluded.

“These findings contribute to the debate on the effectiveness of statin therapy and highlight the need for personalized medicine in lipid management for patients,” they added.

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