Half of patients prescribed statins do not achieve the necessary “healthy” cholesterol levels after two years of treatment, according to a new observational study.
The researchers, whose findings are published online today (15 April 2019) in the latest edition of Heart, say their analysis backs up previous studies and highlights the need for personalised medicine to tackle high cholesterol.
GP leaders said they believed the problem lay with patients failing to take the drugs regularly.
In the UK, the National Institute for Health and Care Excellence (NICE) says that statins should achieve a reduction of 40% or more of LDL cholesterol – but this study showed that only half of patients responded.
The researchers drew on diagnostic and prescribing data submitted anonymously by 681 family doctor practices to the UK Clinical Practice Research Datalink – and linked them to episodes of hospital treatment (HES data) and statistics on cause of death (ONS data).
Complete information was available for 165,411 patients and the researchers found that there was a suboptimal response in 84,609 patients (51%) when it came to achieving a 40% reduction in LDL cholesterol.
Patients who failed to reach the 40% reduction after two years were 22% more likely to develop cardiovascular disease than those who did respond well.
Every 1 mmol/l fall in low density cholesterol was associated with a 6% lower risk of stroke and mini stroke in those who failed to reach the 40% target.
“Currently, there is no management strategy in clinical practice which takes into account patient variations in response, and no guidelines for predictive screening before commencement of statin therapy,” say the researchers.
“These findings contribute to the debate on the effectiveness of statin therapy and highlight the need for personalised medicine in lipid management for patients.”
Royal College of GPs chair Professor Helen Stokes-Lampard said: “There is a substantial body of research showing that statins are safe and effective drugs for most people, and can reduce the risk of heart attacks and stroke, when prescribed appropriately – but controversy remains around their widespread use and their potential side-effects.
“There are complex reasons why patients choose not to take their prescribed medication, and mixed messaging around statins could be one of these.
“We would encourage anyone who is on regular medication to attend their scheduled medication reviews and to raise any queries or concerns they might have. But given the widespread GP shortages and intense workload pressures that we currently have in general practice, it’s hard to know what more we can do to encourage greater compliance with medications that have been recommended in good faith.”
Sub-optimal cholesterol response to initiation of statins and future risk of cardiovascular disease. Heart 16 April 2019; doi 10.1136/heartjnl-2018-314253
http://heart.bmj.com/lookup/doi/10.1136/heartjnl-2018-314253
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