When It Comes to Reducing Cholesterol, Not All Statins Are the Same

Abstract

McDermott et al1McDermott M.M. Reed G. Greenland P. et al.Activating peripheral arterial disease patients to reduce cholesterol: randomized trial.Am J Med. 2011; 124: 557-565Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar have done well to raise the issue of optimizing patient compliance with statin therapy to achieve therapeutic goals in the peripheral arterial disease population. However, their data did not differentiate between types of lipid-lowering therapy or detail the doses that may have affected the response to the intervention, although the authors did document change in dose at 12-month follow-up. If the intervention group had a higher number of patients receiving rosuvastatin or combination lipid-lowering therapy, one might expect the decrease in low-density lipoprotein (LDL) to be more significant. The STELLAR trial2McKenney J.M. Jones P.H. Adamczyk A. et al.Comparison of the efficacy of rosuvastatin versus atorvastatin, simvastatin, and pravastatin in achieving lipid goals: results from the STELLAR trial.Curr Med Res Opin. 2003; 19: 689-698Crossref PubMed Scopus (143) Google Scholar revealed that the rosuvastatin group was more likely to achieve LDL <100 mg/dL when compared with patients on atorvastatin, simvastatin, and pravastatin. In a recent meta-analysis of 13 studies with over 5000 patients, it was discovered that a combination of a statin with ezetimibe was more effective in reaching LDL target goals compared with doubling of statins alone.3Mikhailidis D.P. Lawson R.W. McCormick A.L. et al.Comparative efficacy of the addition of ezetimibe to statin vs statin titration in patients with hypercholesterolaemia: systematic review and meta-analysis.Curr Med Res Opin. 2011; 27: 1191-1210Crossref PubMed Scopus (73) Google Scholar Secondly, the authors document that patients who dropped out were more likely to be older and have a lower educational level. Indeed, in the demographics, the authors document that 12.4% of patients in the intervention group had less than a high school education. Education level also was found to be a significant effect on compliance with osteoporosis medication in a small Turkish trial following patients up over a 3-year period.4Cevikoi A. Umay E. Polat S. Ecerkale O. Cakci A. Relationship between bisphosphonate use and demographic characteristics of male osteoporosis patients.Clinics (Sao Paulo). 2011; 66: 579-582Crossref PubMed Scopus (5) Google Scholar These are precisely the very groups that need our help and further support as physicians when it comes to health literacy and compliance, and as such, the intervention therefore did not seem to benefit this high-risk group. Some patient characteristics, such as low socioeconomic status, psychiatric illness, and substance abuse, also can have a negative consequence on overall patient compliance.5Lowry D.J. Ryan J.D. Ullah N. Kelleher T.B. Crowe J. Hepatitis C management: the challenge of dropout associated with male sex and injection drug use.Eur J Gastroenterol Hepatol. 2011; 23: 32-40Crossref PubMed Scopus (8) Google Scholar Long-term follow-up and reinforcement of the benefits of therapy are necessary to critically evaluate the outcomes of a treatment intervention for any disorder. To conclude, this was an important study aiming to facilitate compliance with medication therapy for a serious and chronic lifelong illness. However, the authors should have given more detail on the lipid-lowering therapy received by the different groups as this could have affected results, and perhaps analyzed reasons for patient noncompliance. Activating Peripheral Arterial Disease Patients to Reduce Cholesterol: A Randomized TrialThe American Journal of MedicineVol. 124Issue 6PreviewPeripheral arterial disease patients are less likely than other high-risk patients to achieve ideal low-density lipoprotein (LDL) cholesterol levels. This randomized controlled trial assessed whether a telephone counseling intervention, designed to help peripheral arterial disease patients request more intensive cholesterol-lowering therapy from their physician, achieved lower LDL cholesterol levels than 2 control conditions. Full-Text PDF The ReplyThe American Journal of MedicineVol. 125Issue 1PreviewWe recently published a randomized controlled clinical trial that evaluated a telephone counseling intervention, designed to help patients with peripheral arterial disease and suboptimal low-density lipoprotein cholesterol (LDL-C) levels influence their physician's cholesterol medication-prescribing practices.1 Intervention participants achieved significantly lower LDL-C levels at 12-month follow-up compared with an attention control condition, but not as compared with a usual care condition.1 Hassan et al question whether a higher proportion of participants taking rosuvastatin or a statin medication combined with ezetimibe in the intervention arm of the randomized controlled clinical trial may have influenced the trial results. Full-Text PDF