Abstract
BackgroundThe 2014 ACC/AHA guidelines redefined the strategy for LDL-cholesterol (LDL-C) treatment. According to data from evidence-based studies, the basis for earlier therapeutic recommendations for LDL-C target levels (2.6 and 1.8 mmol/L) may be disputed, and only the data for the percent LDL-C reduction are objective. The target is a moderate intensity (30–50%) LDL-C reduction in the high cardiovascular (CV) risk group, and a high intensity LDL-C reduction (> 50%) in the very high risk group. In our study, we analysed the success of the two types of strategies in attaining the target in the everyday routine.MethodsOf 5652 patients suffering from hypercholesterolemia, 4302 underwent treat-to-target treatment, and 1350 patients were treated with a percent reduction strategy. Physicians were free to choose the dosage and the target treatment form. The 12-month study included three follow-up visits.ResultsIn the high CV risk, statin-naive subgroup the percent LDL-C reduction strategy has been proven to be clearly more successful than the treat-to-target strategy, i.e. a higher proportion of patients reached the target values. We observed that the absolute value corresponding to a percent reduction target is higher if the baseline LDL-C is higher, and therefore it is easier to reach.ConclusionTherefore, in this large subgroup of patients with baseline LDL-C level higher than 3.9 mmol/L may be recommended the adaptation of the percent reduction assessment.
Highlights
The 2014 American College of Cardiology/American Heart Association (ACC/AHA) guidelines redefined the strategy for LDL-cholesterol (LDL-C) treatment
The guideline recommends the administration of moderate- and high-intensity statin therapy, in contrast to the LDL-cholesterol (LDL-C) treatment targets used earlier [1]
In the high-risk, no-CV symptoms patient cohort, percent reduction had a 68.6% success rate, while treat-to-target had 58.1%, a discrepancy which proved significant (Fig. 1). This means that the percent reduction strategy brings an advantage primarily to the high-risk patients
Summary
The 2014 ACC/AHA guidelines redefined the strategy for LDL-cholesterol (LDL-C) treatment. According to data from evidence-based studies, the basis for earlier therapeutic recommendations for LDL-C target levels (2.6 and 1.8 mmol/L) may be disputed, and only the data for the percent LDL-C reduction are objective. The target is a moderate intensity (30–50%) LDL-C reduction in the high cardiovascular (CV) risk group, and a high intensity LDL-C reduction (> 50%) in the very high risk group. We analysed the success of the two types of strategies in attaining the target in the everyday routine. The new US cholesterol treatment guideline (elaborated by the ACC/AHA societies) was first presented in 2013. The guideline recommends the administration of moderate- and high-intensity statin therapy, in contrast to the LDL-cholesterol (LDL-C) treatment targets used earlier [1]. The guideline clearly states that a detailed review of hard-endpoint major trials used as evidence offers no proof as to what specific absolute target should be used, as there was no evaluation of treatment targets, and no comparison of the attainment of the different treatment targets was done, nor were different dose strengths
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