Abstract 10832: Variability of LDL-C Lowering Responses to Statin Therapy in Achievement of ACC/AHA Target Levels

Abstract

Objective: The recently published ACC/AHA 2013 cholesterol guidelines do not specify lipid target levels, but rather treatment of patients classified by cardiovascular risk to achieve LDL-C reductions of ≥50% and ≥30 - <50% with high and moderate intensity statin therapy respectively. This analysis evaluated the variability of treatment responses to statin therapy for these parameters in statin-naïve patients with hypercholesterolemia (HC). Methods: Data pooled from 14 randomized, controlled, double-blind clinical trials in HC patients were categorized per the 4 risk groups specified by ACC/AHA 2013 guidelines: 1) atherosclerotic cardiovascular disease (ASCVD), 2) baseline LDL-C >190 mg/dL, 3) diabetes (DM) and 4) 10 year ASCVD risk ≥7.5% (no ASCVD or DM). Mean % change from baseline in LDL-C, the percentage of patients who attained LDL-C reductions of ≥50% and ≥30 - <50% and variability of LDL-C lowering responses on recommended therapy among risk groups were assessed. Results: Mean % LDL-C changes from baseline ranged from -49.5 to -52.2% and -37.7 to -40.5% on high and moderate intensity statins, respectively across risk groups (Figure). The percentages of patients who achieved LDL-C reductions of ≥50% on high intensity statins were 62 - 70%, and who attained reductions ≥30 - <50% were 52 - 60% (77 - 89% for ≥30%) on moderate intensity therapy. The variability of % changes from baseline in LDL-C (SE = 0.7 to 2.1) and proportions of patients who achieved target LDL-C reductions were generally similar across risk groups for high and medium intensity statins. Conclusion: In this analysis, only 2/3 of patients achieved LDL-C reductions ≥50% on high intensity statins and ~80% of patients attained reductions ≥30% on moderate statin therapy. These results highlight the importance of assessing the response of patients to cholesterol lowering therapy when following the AHA/ACC guidelines and consideration of alternatives for those patients in need of greater LDL-C lowering.