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Achievement of 2011 European low-density lipoprotein cholesterol (LDL-C) goals of either <70 mg/dl or ≥50% reduction in high-risk patients: Results from VOYAGER

      Abstract

      Objective

      Guidelines published in 2011 by the European Atherosclerosis Society and the European Society of Cardiology recommend a goal of either low-density lipoprotein cholesterol (LDL-C) <70 mg/dl (∼1.8 mmol/l) or ≥50% reduction in LDL-C for patients at very high cardiovascular risk. The aim of this study was to determine the percentage of high-risk patients from the VOYAGER individual patient data meta-analysis treated with rosuvastatin 10–40 mg, atorvastatin 10–80 mg or simvastatin 10–80 mg who achieved this goal.

      Methods

      We analysed 25,075 patient exposures from high-risk patients. Paired comparisons were made between each rosuvastatin dose and an equal or higher dose of either atorvastatin or simvastatin, with a series of meta-analyses that included only randomised studies that directly compared rosuvastatin and its comparator treatments.

      Results

      As statin dose increased, higher percentages of patients achieved LDL-C <70 mg/dl or ≥50% LDL-C reduction. A greater percentage achieved this goal with rosuvastatin 10–40 mg (43.8–79.0%) than with equal or double milligram doses of atorvastatin (16.1–65.2%) or simvastatin (0–39.7%).
      Paired comparisons showed statistically significant differences for: rosuvastatin 10 mg vs. atorvastatin 10–20 mg and simvastatin 10–20 mg; rosuvastatin 20 mg vs. atorvastatin 20–40 mg and simvastatin 20–80 mg; and rosuvastatin 40 mg vs. atorvastatin 40–80 mg and simvastatin 40–80 mg (all p < 0.001).

      Conclusion

      These data from VOYAGER highlight the importance of an effective statin at an appropriate dose to achieve treatment goals for LDL-C in patients with very high cardiovascular risk.

      Highlights

      • We analysed 2011 EAS/ESC guidelines on LDL-C goals for very high-risk patients.
      • Information from the VOYAGER individual patient data meta-analysis was used.
      • With high statin dose goal attainment (LDL-C <70 mg/dl or ≥50% reduction) improved.
      • More reached goal with rosuvastatin than with equal/double doses of other statins.
      • These data show the importance of using an effective statin at an appropriate dose.

      Keywords

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      References

        • Mathers C.D.
        • Loncar D.
        Projections of global mortality and burden of disease from 2002 to 2030.
        PLoS Med. 2006; 3: e442
        • Rosensen R.S.
        Statins: can the new generation make an impression?.
        Expert Opin Emerg Drugs. 2004; 9: 269-279
        • LaRosa J.
        • Grundy S.M.
        • Waters D.D.
        • et al.
        Intensive lipid lowering with atorvastatin in patients with stable coronary disease.
        N Engl J Med. 2005; 352: 1425-1435
        • Cholesterol Treatment Trialists' (CTT) Collaboration
        Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials.
        Lancet. 2010; 376: 1670-1681
        • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
        Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III).
        J Am Med Assoc. 2001; 285: 2486-2497
        • Grundy S.M.
        • Cleeman J.I.
        • Merz C.N.B.
        • et al.
        Implications of recent clinical trials for the National Cholesterol Education Program adult treatment panel III guidelines.
        Circulation. 2004; 110: 227-239
        • Graham I.
        • Atar D.
        • Borch-Johnsen K.
        • et al.
        European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts).
        Eur J Cardiovasc Prev Rehabil. 2007; 14: S1-S113
        • Reiner Z.
        • Catapano A.L.
        • De Backer G.
        • et al.
        ESC/EAS guidelines for the management of dyslipidaemias: the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS).
        Eur Heart J. 2011; 32: 1769-1818
        • Perk J.
        • De Backer G.
        • Gohlke H.
        • et al.
        European guidelines on cardiovascular prevention in clinical practice (version 2012). The fifth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts).
        Eur J Prev Cardiol. 2012; 19: 585-667
        • Conroy R.M.
        • Pyörälä K.
        • Fitzgerald A.P.
        • et al.
        Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.
        Eur Heart J. 2003; 24: 987-1003
        • Nicholls S.J.
        • Brandrup-Wognsen G.
        • Palmer M.
        • Barter P.J.
        Meta-analysis of comparative efficacy of increasing dose of atorvastatin versus rosuvastatin versus simvastatin on lowering levels of atherogenic lipids (from VOYAGER).
        Am J Cardiol. 2010; 105: 69-76
        • Barter P.J.
        • Brandrup-Wognsen G.
        • Palmer M.K.
        • Nicholls S.J.
        Effect of statins on HDL-C: a complex process unrelated to changes in LDL-C: analysis of the VOYAGER database.
        J Lipid Res. 2010; 51: 1546-1553
        • Karlson B.W.
        • Nicholls S.J.
        • Lundman P.
        • Barter P.J.
        • Palmer M.K.
        Baseline LDL-C and choice and dose of statin as determinants of LDL-C goal achievement: meta-analysis from the VOYAGER database.
        Eur Heart J. 2011; 32: 342
        • Kitkungvan D.
        • Lynn Fillipon N.M.
        • Dani S.S.
        • Downey B.C.
        Low-density lipoprotein cholesterol target achievement in patients at high risk for coronary heart disease.
        J Clin Lipidol. 2010; 4: 293-297
      1. FDA drug safety communication: new restrictions, contraindications, and dose limitations for Zocor (simvastatin) to reduce the risk of muscle injury. US Food and Drug Administration, June 8, 2011 (Available from:) ([accessed 10.01.2013])