To what extent do high-intensity statins reduce low-density lipoprotein cholesterol in each of the four statin benefit groups identified by the 2013 American College of Cardiology/American Heart Association guidelines? A VOYAGER meta-analysis.

Abstract

The 2013 American College of Cardiology and American Heart Association (ACC/AHA) guidelines identify four patient groups who benefit from moderate- or high-intensity statin treatment; those with: 1) atherosclerotic cardiovascular disease (ASCVD); 2) low-density lipoprotein cholesterol (LDL-C) ≥190mg/dl; 3) diabetes; or 4) a 10-year ASCVD risk ≥7.5%. High-intensity statins, anticipated to reduce LDL-C by≥50%, were identified as rosuvastatin 20-40mg and atorvastatin 40-80mg. Individual patient data (32,258) from the VOYAGER database of 37 studies were used to calculate least-squares mean (LSM) percentage change in LDL-C during 8496 patient exposures to rosuvastatin 20-40mg, and atorvastatin 40-80mg in the four patient benefit groups. LSM percentage reductions in LDL-C with rosuvastatin 20 and 40mg were greater than with atorvastatin 40mg, overall and in each statin benefit group, and with rosuvastatin 40mg were greater than with atorvastatin 80mg overall and in three of the four benefit groups (all p<0.05). For example, in the ASCVD group, 40%, 59%, 57% and 71% of patients treated with atorvastatin 40mg, atorvastatin 80mg, rosuvastatin 20mg and rosuvastatin 40mg, respectively, had a ≥50% reduction in LDL-C. The choice and dose of statin have an impact both on the percentage LDL-C reduction and achievement of ≥50% reduction in LDL-C, overall and within each of the four statin benefit groups outlined by the 2013 ACC/AHA guidelines. This may be of importance for clinicians in their choice of treatment for individual patients.