Treatments
Monitoring therapy
LDL-cholesterol monitoring:
The cardiovascular benefits of cholesterol lowering lipid therapy are dependant on a patient’s individual level of cardiovascular risk.1 Every statin prescribing decision should therefore be based on your assessment of a patient’s individual cardiovascular risk. Your decision to initiate a particular statin therapy at a particular time should take into account an individual patient’s needs, including their cardiovascular risk.
Studies have demonstrated a correlation between the reduction of LDL-C with statin therapy and cardiovascular risk. Statin therapy was shown to reduce the 5-year incidence of first major coronary events by 23% with every 1 mmol/L reduction in LDL-C.2
Dose titration:
It is also important to regularly re-assess patients during statin treatment, to determine whether their individual level of cardiovascular risk has changed since initiation. This ongoing assessment of patients should define any change in the choice of treatment. In some cases, the long-term outcome of a patient can be improved by increasing the dose of statin.3
In high-risk patients with existing coronary heart disease (CHD), atorvastatin 80 mg has been shown to achieve a 22% relative risk reduction in major cardiovascular events compared with atorvastatin 10 mg. This benefit was maintained over a median follow-up of 4.9 years. Therefore, in high-risk patients it is important to maintain high intensity statin therapy for sustained cardiovascular benefits.3
Adherence:
In making a prescribing decision, non-adherence to a cholesterol lowering medication is a significant clinical problem,4 which may impact cardiovascular outcomes.5
If a patient experiences a change in their statin therapy, their adherence to the new treatment may be affected. Atorvastatin has demonstrated a significant impact on cardiovascular risk, whilst improving the likelihood of adherence.3 In an observational study using the THIN (The Health Improvement Network) database in the UK, patients switched to simvastatin were more than twice as likely to discontinue treatment compared to patients remaining on atorvastatin.5
References:
1. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice. Eur J Cardiovasc Prev Rehab 2007; 14: E1-E40.
2. Cholesterol Treatment Collaborators (CTT), Lancet 2005; 366: 1267-1278.
3. LaRosa JC et al. N Engl J Med 2005; 352: 1425-1435.
4. Senior V et al. Cardiovascular Drugs and Therapy 2004; 18: 475-481.
5. Phillips B et al. Br J Cardiol 2007; 14:280-285.