Abstract P195: Combination Therapy not the Intensity of Statin Therapy Improves LDL Goal Attainment in Clinical Practice
Background: In clinical practice most coronary heart disease (CHD) patients (pts) are not achieving their recommend LDL goal of < 70 mg/dL. We assessed the impact of statin dose and combination therapy in achieving optimal LDL levels in CHD pts.
Methods: We conducted a retrospective analysis of outpatient electronic health records (EHR) from a large cardiology practice from September 2008 to September 2009. The most recent lipid profile, lipid-lowering medications and doses were extracted from the EHR. Statin potency was assessed based on the brand and dose of statin.
Results: We identified 9,950 CHD pts; 59% were on a statin alone (SA), 27% on a statin + another lipid-lowering drug, 4% on no statin but on another lipid-lowering drug and 10% were on no lipid-lowering drugs. Only 37% of SA pts achieved an LDL < 70 mg/dL, but did so more often than pts on no statin but on another lipid-lowering drug (37 vs. 18%; p < 0.0001). Among SA pts, 70% were on moderate to high potency statins. The intensity of statin therapy did not improve LDL goal attainment. Among pts on combination therapy, 41% on statin + ezetimibe (S+E) and 46% on statin + niacin (S+N) achieved an LDL < 70 mg/dL (p = 0.01 and < 0.0001 vs. SA). Only 14% of pts were on S+E and 9% on S+N. Statin plus fibrate did not improve LDL goal attainment compared to SA (35 vs. 37%; p = 0.23). Few pts were taking bile acid sequestrants (< 0.5%). If pts were switched to a high potency statin LDL goal attainment of < 70 mg/dL would increase to 46% and would increase further to 65% with combination therapy.
Conclusions: Most CHD pts in clinical practice do not attain an LDL < 70 mg/dL, even among pts on high potency statins. The number of CHD pts on no statin is high. The combination of statin plus either ezetimibe or niacin is the most effective regimen to achieve an LDL < 70 mg/dL; however these drug combinations are used infrequently in clinical practice. Combination lipid-lowering therapy is needed to improve LDL goal attainment in CHD pts.
- © 2012 by American Heart Association, Inc.