Achievement of English National Service Framework lipid-lowering goals: pooled data from recent comparative treatment trials of statins at starting doses

Despite the importance of reducing cardiovascular disease (CVD) risk, detailed in guidelines in many countries, repeated surveys show poor physician performance in attaining guideline lipid targets, which is associated with reluctance by physicians to up-titrate statins from starting doses. Data from randomised, double-blind trials comparing common starting doses of atorvastatin, pravastatin, rosuvastatin and simvastatin for 12 weeks in hypercholesterolaemic patients were therefore analysed for achievement of lipid-lowering goals recommended by the England National Service Framework (NSF) for coronary heart disease (CHD). In three pooled trials, rosuvastatin 10 mg (n = 389) reduced low-density lipoprotein cholesterol (LDL-C) and total cholesterol more significantly than atorvastatin 10 mg (n = 393) (p < 0.001). NSF goals were achieved by 83% of rosuvastatin patients vs. 55% of atorvastatin patients (p < 0.001) at relevant starting doses. In two pooled trials, rosuvastatin 10 mg (n = 226) reduced LDL-C and total cholesterol more significantly than simvastatin 20 mg (n = 249) and pravastatin 20 mg (n = 252) (p < 0.001). NSF goals were achieved at starting doses by 83% of rosuvastatin patients vs. 51% of simvastatin patients and 19% of pravastatin patients (p < 0.001 vs. each comparator). This improved achievement of NSF lipid target, at starting doses, was also seen in high-risk patients (those eligible for secondary prevention or primary prevention because of a 10-year CVD risk of >30%) with 84% patients on rosuvastatin vs. 58% on atorvastatin and 75% of patients on rosuvastatin vs. 49% on simvaststin and 24% on pravastatin. In summary, there are considerable and clinically significant variations in the achievement of lipid goals between common starting doses of statins in hypercholesterolaemic patients.