ANN ARBOR, Mich.—A tailored treatment strategy that considers a patient’s risk factors, such as age, family history and smoking status, prevents more coronary artery disease (CAD) events, and uses fewer high-dose statin drugs, than current strategies to drive down cholesterol to a certain target, according to a new study published in the Annals of Internal Medicine (2010 Jan 19;152(2):69-77).
University of Michigan Medical School researchers challenged the recommendation that people with high low-density lipoprotein (LDL) cholesterol levels should try to lower it to 130 for most people, or to less than 70 for high-risk patients. Instead, they examined a tailored treatment, which uses a person’s risk factors and mathematical models to calculate the expected benefit of treatment, by considering: a person’s risk of a heart attack or stroke without treatment, how much a statin decreases the risk, and potential harms from the treatment.
Researchers used data from statin trials from 1994 to 2009 that included Americans ages 30 to 75 with no history of heart attack. They evaluated the benefit of five years of tailored treatment on coronary artery disease risk factors such as age, family history, diabetes, high blood pressure, smoking status and C-reactive protein (CRP) levels.
They found the tailored (simvastatin, 40 mg, for 5 to 15 percent CAD risk and atorvastatin, 40 mg, for CAD risk less than 15 percent) approach was more efficient (more benefit per person treated) and prevented substantially more heart attacks, strokes and cardiovascular deaths than the currently recommended treat-to-target approaches set forth by the National Cholesterol Education Program [NCEP] III guidelines. The tailored strategy also treated fewer individuals with high-dose statins and saved 500,000 more quality-adjusted life years.
Researchers said they found no circumstances where a treat-to-target approach was preferable to tailored treatment.