To what extent do high-intensity statins reduce low-density lipoprotein cholesterol in each of the four statin benefit groups identified by the 2013 American College of Cardiology/American Heart Association guidelines? A VOYAGER meta-analysis

被引:18
作者
Karlson, Bjorn W. [1 ,2 ]
Palmer, Michael K. [3 ]
Nicholls, Stephen J. [4 ]
Lundman, Pia [5 ]
Barter, Philip J. [6 ]
机构
[1] AstraZeneca R&D, SE-43183 Molndal, Sweden
[2] Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Mol & Clin Med, SE-41345 Gothenburg, Sweden
[3] Keele Univ, Keele ST5 5BG, Staffs, England
[4] Univ Adelaide, South Australian Hlth & Med Res Inst, Adelaide, SA, Australia
[5] Karolinska Inst, Danderyd Hosp, Div Cardiovasc Med, Dept Clin Sci, Stockholm, Sweden
[6] Univ New S Wales, Sydney, NSW, Australia
关键词
ACC/AHA guidelines; Atorvastatin; Low-density lipoprotein cholesterol; Rosuvastatin; LDL-C GOALS; DYSLIPIDEMIA; ACHIEVEMENT; MANAGEMENT; EFFICACY; SOCIETY; TRIALS; DRUGS; RISK;
D O I
10.1016/j.atherosclerosis.2015.05.029
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
Background: The 2013 American College of Cardiology and American Heart Association (ACC/AHA) guidelines identify four patient groups who benefit from moderate-or high-intensity statin treatment; those with: 1) atherosclerotic cardiovascular disease (ASCVD); 2) low-density lipoprotein cholesterol (LDL-C) >= 190 mg/dl; 3) diabetes; or 4) a 10-year ASCVD risk >= 7.5%. High-intensity statins, anticipated to reduce LDL-C by >= 50%, were identified as rosuvastatin 20-40 mg and atorvastatin 40-80 mg. Methods and Results: Individual patient data (32,258) from the VOYAGER database of 37 studies were used to calculate least-squares mean (LSM) percentage change in LDL-C during 8496 patient exposures to rosuvastatin 20-40 mg, and atorvastatin 40-80 mg in the four patient benefit groups. LSM percentage reductions in LDL-C with rosuvastatin 20 and 40 mg were greater than with atorvastatin 40 mg, overall and in each statin benefit group, and with rosuvastatin 40 mg were greater than with atorvastatin 80 mg overall and in three of the four benefit groups (all p < 0.05). For example, in the ASCVD group, 40%, 59%, 57% and 71% of patients treated with atorvastatin 40 mg, atorvastatin 80 mg, rosuvastatin 20 mg and rosuvastatin 40 mg, respectively, had a >= 50% reduction in LDL-C. Conclusions: The choice and dose of statin have an impact both on the percentage LDL-C reduction and achievement of >= 50% reduction in LDL-C, overall and within each of the four statin benefit groups outlined by the 2013 ACC/AHA guidelines. This may be of importance for clinicians in their choice of treatment for individual patients. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:450 / 454
页数:5
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