Tailored cholesterol treatment vs treat-to-target simulation model

January 01, 0001

Tailored cholesterol treatment vs treat-to-target simulation model

These US authors examined how a tailored treatment approach to statin therapy compares with a treat-to-target approach using a simulation model based on nationally representative CAD risk factor data for persons aged 30-75 years with no history of myocardial infarction estimating the l effects of 5 years of treatment. The simulated interventions were simvastatin, 40 mg, for 5% to 15% CAD risk and atorvastatin, 40 mg, for CAD risk greater than 15%) versus treat-to-target approaches that escalate statin dose per National Cholesterol Education Program (NCEP) III guidelines.

Results of base-case analysis were: "Compared with the standard NCEP III approach, the intensive NCEP III approach treated 15 million more persons and saved 570 000 more QALYs over 5 years. The tailored strategy treated a similar number of persons, as did the intensive NCEP III approach, but saved 500 000 more QALYs and treated fewer persons with high-dose statins."

The authors concluded: "A tailored treatment strategy prevents more CAD events while treating fewer persons with high-dose statins than low- density lipoprotein cholesterol-based target approaches. Results were robust, even with assumptions favoring a treat-to-target approach."

At minimum these results should prompt a large randomized trial.

For the full abstract, click here.

Ann Intern Med 152(2):69-77, 19 January 2010
© 2010 to the American College of Physicians
Optimizing Statin Treatment for Primary Prevention of Coronary Artery Disease. Rodney A. Hayward, Harlan M. Krumholz, Donna M. Zulman, Justin W. Timbie, and Sandeep Vijan. Correspondence to: Dr. Hayward: rhayward@umich.edu

Category: K Circulatory Keywords: cholesterol treatment, coronary artery disease, quality-adjusted life years, QALYs, simulation model, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 02 February 2010

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