Effectiveness of lipid-lowering therapy with statins for secondary prevention of atherosclerosis - Guidelines vs. reality

Background: the aim of the study was to analyze the effectiveness of lipid-lowering therapy and therapeutic decisions made by physicians for patients not achieving ldl targets. methods: 11,768 patients undergoing therapy with statins for secondary prevention of atherosclerosis participated in a two-visit survey. in subjects not achieving the ldl-target (< 100 mg/dl),further therapeutic decisions made by physicians were recorded. results: initially the ldl-target was achieved by 7.8% of patients on simvastatin and by 18.0% on atorvastatin,of which 20.8% were treated with at least a 40 mg dose. the most common changes in therapy to improve effectiveness was substituting simvastatin for another statin (75.2%,usually atorvastatin),or increasing atorvastatin dosage (59.8%). intensification of a low fat diet and weight reduction weremore frequently recommended in treatment with atorvastatin than with simvastatin (59.8%vs. 55.9%,p < 0.001). after enhanced therapy,the ldl-target was achieved by 27.8%on simvastatin and by 35.0%on atorvastatin (p < 0.001). in those with ldl levels remaining above the target,substitution of simvastatinwith atorvastatin (49.9%),or the increase of atorvastatin dose (41.4%)was recommended. as previously,life-style counseling was more frequent in patients on atorvastatin (66.1% vs. 45.7%; p < 0.001). conclusions: 1. the use of low dose statins and noncompliance with behavioral modification guidelines are responsible for the low levels of effectiveness found with lipid-lowering therapies. 2. physicians prefer substitution of less effective statins over the increase of dose in patients not achieving ldl targets. 3. life-style changes are under-prescribed by physicians and under-implemented by their patients. copyright © 2012 by institute of pharmacology polish academy of sciences.