Flexible Initial Dosing of Atorvastatin Based Upon Initial Low-Density Lipoprotein Cholesterol Levels in Type 2 Diabetic Patients

Son, Ho Young; Yoon, Kun‐Ho; Choi, Yoon Hee; Kwon, Hyuk Sang; Ko, Seung Hyun; Lee, I. K.; Kim, H. S.; Park, K. K.; Kim, M. J.; Woo, Jeong Taek; Kim, Y. S.; Choi, Dong-Hwan; Lee, M. K.; Kim, H. J.; Park, K. S.; Lee, H. K.; Park, J. Y.; Koh, Eun Hee; Lee, H. C.; S., B.; Chung, Min Young; Cho, D. H.; Kim, Y. K.; Kim, I. J.; Ku, Bon Jeong

doi:10.3904/kjim.2008.23.1.22

Cited by 10 publications

(6 citation statements)

References 22 publications

(12 reference statements)

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“…Unfortunately, however, collecting data on adverse events after treatment with statins was difficult in our study, because the events were not recorded well. In a prior study in the Korean population, treatment-emergent adverse events tended to be more frequent with higher-dose statins [14]. Meanwhile, most statin-related adverse events were mild and totally reversible in other Korean studies [15, 16] and the discontinuation rate of statins has been very low even in patients receiving the maximum available dose of rosuvastatin [16].…”

Section: Discussionmentioning

confidence: 99%

Statin Intensity and Clinical Outcome in Patients with Stable Coronary Artery Disease and Very Low LDL-Cholesterol

Lee

Kim

et al. 2016

PLoS ONE

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BackgroundAlthough intensive statin therapy is recommended for high risk patients, evidence of its benefit in patients with stable coronary artery disease (CAD) and very low low-density lipoprotein-cholesterol (LDL-C) has been very rare. In this study, we investigated whether higher statin intensity reduces cardiovascular risks in this population.MethodsIn this retrospective study, a total of 5234 patients with stable CAD were screened at three tertiary hospitals in Korea; 449 patients (mean age: 65 years, male: 69%) with LDL-C <80 mg/dL were finally analyzed. The statin intensities were classified according to the 2013 American College of Cardiology/American Heart Association guidelines. Patients who received statins equivalent to or weaker than atorvastatin 10 mg (group 1) were compared with those who took statins equivalent to or stronger than atorvastatin 20 mg (group 2). The impact of statin intensity on major adverse cardiac events (MACE) was evaluated during follow-up.ResultsGroup 1 and group 2 consisted of 181 patients (40.3%) and 268 patients (59.7%), respectively. The mean LDL-C level decreased to 52 and 57 mg/dL in group 1 and group 2, respectively, during follow-up. In a median follow-up of 4.5 years, patients of group 2 had a lower incidence of MACE (30 [16.6%] vs. 12 [4.5%], p <0.001), which were mostly related to a lower incidence of coronary revascularization. Cox proportional hazard analyses identified the statin intensity of group 2 (adjusted hazard ratio: 0.25, confidence interval: 0.11–0.55, p <0.001) and the baseline high-density lipoprotein-cholesterol level as independent determinants of MACE.ConclusionThis study provides evidence that higher intensity statins are beneficial for cardiovascular outcomes in patients with stable CAD and very low LDL-C. Statins equivalent to or stronger than atorvastatin 20 mg are more effective than lower intensity statins.

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Section: Discussionmentioning

confidence: 99%

Statin Intensity and Clinical Outcome in Patients with Stable Coronary Artery Disease and Very Low LDL-Cholesterol

Lee

Kim

et al. 2016

PLoS ONE

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“…We infer that it is necessary to increase the dosage of atorvastatin by at least double for the 'Non-responder group'. Moreover, if patients do not show a response to a 20 mg dosage, they may need to increase to the maximal dosage of atorvastatin monotherapy [ 7 , 8 ], and a prompt up-titration should also be applied [ 11 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study on the Efficacy of a Ten-Milligram Dosage of Atorvastatin for Treatment of Hypercholesterolemia in Type 2 Diabetes Mellitus Patients

et al. 2010

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BackgroundThere have been few clinical studies on 10 mg atorvastatin as a starting dosage for treatment of hypercholesterolemia in type 2 diabetes mellitus (T2DM) patients. This retrospective study aims to evaluate the efficacy of 10 mg dosage of atorvastatin in clinical setting.MethodsOne hundred five enrolled patients with high levels of low density lipoprotein cholesterol (LDL-C, > 100 mg/dL) took 10 mg atorvastatin. After 6 months, they were divided into 'Responder group' (LDL-C < 100 mg/dL) and 'Non-responder group' (LDL-C ≥ 100 mg/dL), and the response rate was calculated. Thereafter, we subdivided the 'Responder group' into Maintenance (10 mg), Reduced dosage (5 mg), and Discontinuance group (0 mg). The 'Non-Responder group' was subdivided into Maintenance (10 mg) and Double dosage group (20 mg). After consecutive 6 months, the response rates of each 10 mg Maintenance groups were compared to those of the other groups, respectively.ResultsFollowing the first 6 months, the response rate of 10 mg fixed dosage was 74.3%. In the 'Responder group', response rates of 10 mg, 5 mg and Discontinuance groups following 6 months were 52.6%, 53.1%, and 12.5%, respectively. In the 'Non-responder group', response rates of 10 mg and 20 mg groups were 28.6% and 50.0%. Baseline LDL-C levels and body mass index (BMI) of 'Responder group' were significantly lower than those of 'Non-responder group' (P = 0.004, respectively).ConclusionHypercholesterolemia treatment with 10 mg, fixed dosage of atorvastatin was effective in three quarters of the subjects during the first 6-month treatment; however, a significant number of patients with high LDL-C levels and/or BMI require higher starting and maintenance dosage.

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“…The Atorvastatin Study Group in Korea assessed a sliding scale dosing approach based on initial LDL-C measurements in patients with type 2 diabetes mellitus. 20 This study allowed 1 dosage titration midway through the study at 4 weeks. At the end of the trial, 89.3% of patients achieved their LDLC treatment goal.…”

Section: Discussionmentioning

confidence: 99%

“…The Atorvastatin Study Group in Korea evaluated the flexible dosing of atorvastatin (dose range 10 to 40 mg/day) based on the LDL-C in type 2 diabetes patients 20. The primary outcome was the percentage of patients meeting the goal LDL-C of 100 mg/dL following 8 weeks of therapy.…”

Section: Clinical Evidence In Type 2 Diabetes Patientsmentioning

confidence: 99%

“…The Atorvastatin Study Group in Korea evaluated the flexible dosing of atorvastatin (dose range 10 to 40 mg/day) based on the LDL-C in type 2 diabetes patients. 20 The primary outcome was the percentage of patients meeting the goal LDL-C of 100 mg/dL following 8 weeks of therapy. Additional measurements were the percentage change over 8 weeks in HDL-C, TG, TC, non-HDL, ratio of LDL to HDL and non lipid-lowering effects such as flow-mediated endothelium-dependent dilation (FMD), flow-mediated endothelium independent dilation (EID) and plasminogen activator inhibitor type 1 (PAI-1).…”

Section: Clinical Evidence In Type 2 Diabetes Patientsmentioning

confidence: 99%

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Individualized initiation of statin therapy determined by baseline LDL-C: Are you more likely to achieve goal LDL-C?

Clem

Strain²,

Farver³

2009

RMHP

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Cardiovascular disease remains the leading cause of death in the world. A significant amount of clinical data are available to demonstrate the positive influence that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy has on slowing the progression of cardiovascular disease and improving clinical outcomes. Achieving the treatment goals for cholesterol in cardiovascular disease continues to present challenges. Recent clinical trial information is available assessing the use of more aggressive initial doses of statin therapy based on initial low-density lipoprotein cholesterol (LDL-C) measurements in an attempt to reach treatment goals sooner. Six clinical trials assessed low-, moderate- and high-risk individuals as well as those with type 2 diabetes mellitus to determine if this treatment approach is both safe and effective. The studies concluded that initial dosing of statin therapy determined by a baseline LDL-C measurement demonstrates good achievement in reaching treatment goals and does not result in a higher rate of adverse effects.

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Flexible Initial Dosing of Atorvastatin Based Upon Initial Low-Density Lipoprotein Cholesterol Levels in Type 2 Diabetic Patients

Cited by 10 publications

References 22 publications

Statin Intensity and Clinical Outcome in Patients with Stable Coronary Artery Disease and Very Low LDL-Cholesterol

Statin Intensity and Clinical Outcome in Patients with Stable Coronary Artery Disease and Very Low LDL-Cholesterol

A Retrospective Study on the Efficacy of a Ten-Milligram Dosage of Atorvastatin for Treatment of Hypercholesterolemia in Type 2 Diabetes Mellitus Patients

Individualized initiation of statin therapy determined by baseline LDL-C: Are you more likely to achieve goal LDL-C?

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