4 Lipid-Lowering Studies Pharmacists Must Know About

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According to results from the Canadian Health Measures Survey (CHMS), approximately 39% of Canadians aged 6 to 79 have an unhealthy level of total cholesterol, while 12% of 20 to 39 year olds, and 40% of 40 to 59 year olds are living with unhealthy LDL cholesterol levels.

Alarmingly, statistics show that people with high total cholesterol have about twice the risk of heart disease as people with ideal levels, while 29% of all deaths in Canada are caused by heart disease, stroke and other cardiovascular diseases.

During the last several years, there have been a number of notable clinical studies on lipid-lowering and cardiovascular health that have been published, which impacts how patients are treated. Here are 4 studies that pharmacists should be aware of:

CARDS (2004)1:
For Primary Prevention- This trial studied the use of Atorvastatin 10mg once daily in Type 2 diabetics aged 40-75 with 1 or more cardiovascular risk factors and no history of CHD or CVD. Cardiovascular benefit was demonstrated even when LDL levels were below targets. NNT was 32 pts over 4 years to prevent first major cardiovascular event. No statistical difference was found for all cause mortality.

ASCOT (2003)2:
For Primary Prevention – This trial looked at the use of Atorvastatin 10mg once daily in patients with high cardiovascular risk (defined as having hypertension plus an average of 3.8 additional risk factors). Cardiovascular benefits were seen and were more pronounced in women over the age of 60. NNT was 91 pts over 3.3 years to prevent a non-fatal MI or CV death. No statistical difference was found for all cause mortality.

PROVE-IT (2004)3:
For Secondary Prevention – Atorvastatin 80mg was found to be superior to Pravastatin 40 mg once daily in ACS patients in decreasing death, major cardiovascular events and stroke. NNT was 26 over 2 years and some patients experienced an increase in LFTs.

IDEAL (2005)4:
For Secondary Prevention – Atorvastatin 80mg once daily was found to decrease risk of major CV event or stroke when compared to simvastatin 20-40mg once daily in patients with a previous history of MI, thereby suggesting that intensive statin therapy confers benefit in reducing major cardiovascular events and stroke when compared to low-moderate statin therapy in high risk patients.

References

Colhoun HM, Betteridge DJ, Durington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in Type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004 Aug 21-27;364(9435):685-96.
Sever PS, Dahlof B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower than average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial- Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003;Apr 5;361(9364):1149-58.
Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;Apr 8;350(15):1495-504
Pederson TR, Faergeman O, Kastelein JJ, et al. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial.JAMA. 2005; Nov 16;294(19):2437-45.