Abstract 11923: LDL-cholesterol Control by Atorvastatin Monotherapy is Suboptimal in High-risk Patients with Coronary Heart Disease or Atherosclerotic Vascular Disease in the US

Abstract

Objective: Lowering LDL-cholesterol (LDL-C) is associated with improved outcomes in patients at high risk for cardiovascular disease. LDL-C goals recommended by NCEP ATP III are dependent upon pre-existing cardiovascular risk factors. Statins are the first recommended pharmacotherapy. Since the availability of generic atorvastatin will likely increase its use, this analysis examined LDL-C goal attainment in high-risk US patients treated with atorvastatin monotherapy.

Methods: In this retrospective study using the GE Healthcare Centricity database, patients who received a prescription for atorvastatin monotherapy (the index Rx) between 01/01/08 and 12/31/10 were identified. They were selected for the analysis if they also had an ICD-9 diagnosis or CPT procedure code indicated for coronary heart disease or atherosclerotic vascular disease, ≥ 1 LDL-C measurement between 3 mo and 1 yr post index Rx, and medical records for 1 yr prior to and following index Rx. Endpoints included the proportion of patients with an LDL-C <70 mg/dL and <100 mg/dL.

Results: Of the 10,693 high-risk patients (mean age 68 yrs [SD 10]; 59% males) who met the selection criteria, 21.8, 29.6, 29.9, and 18.7% received prescriptions for 10-mg, 20-mg, 40-mg, and 80-mg dose of atorvastatin, respectively. Overall, mean follow-up LDL-C was 83 (SD 30) mg/dL. For goal attainment, overall only 35% of patients had an LDL-C <70 mg/dL and 78% had an LDL-C <100 mg/dL, with generally similar goal attainment regardless of dose (Table).

Conclusions: In US patients at high CV risk, the proportion achieving recommended LDL-C goals with atorvastatin monotherapy was suboptimal, with more than 60% not achieving the current optional LDL-C goal of <70 mg/dL regardless of dose. This suggests that more effective lipid-lowering strategies such as add-on therapy, are required to achieve therapeutic goals in high-risk patients.