Lipid lowering efficacy of atorvastatin

Adams, Stephen P.; Tsang, Michael; Wright, James M

doi:10.1002/14651858.cd008226.pub2

Cited by 88 publications

(67 citation statements)

References 396 publications

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“…An important component of hypertension management is cardiovascular risk reduction (28) . Clinical trial like ASCOT have reported that management of dyslipidemia using statins leads to greater reduction of clinical events as compared to isolated BP control (23) . In our study shows that majority of the patients with hypertension had comorbid dyslipidemia and Atorvastatin is the most commonly used lipid lowing agent among the Doctors (70.6%) in HEART study.…”

Section: Discussionmentioning

confidence: 99%

Expert Opinion on Hypertension Management: An Indian Observational Study

Shah

Sadananda²,

Makhale³

et al. 2017

IAM

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Background: Hypertension prevalence in India is increasing significantly in last decade. An observational study was conducted to assess prevalence of Hypertension, its determinants like patient adherence to diet, exercise and pharmacotherapy in routine clinical practice. Methodology: A cross sectional, questionnaire based study was conducted to collect opinion among doctors in cardiology practice across India between January to April 2017. Convenient sampling method was used. Results: A questionnaire booklet titled 'HEART study (Experts Opinion on HypertEnsion And its tReatmenT)' was distributed to doctors who had given written informed consent to participate in the study. 442 completely filled booklets were assessed. The HEART study results highlights that 78% of doctors diagnosed >20 new cases of hypertension every month. Patient's adherence to physical activity and diet was rated as poor by 70% of doctors.. 67% respondents prescribed Angiotensin Receptor Blockers (ARB) and Telmisartan (52.7%) was most opted ARB followed by Olmesartan (24.5%) and Losartan (21%), Valsartan (1.8%). Majority of doctors (92%) opined that >60% of hypertensive patients require second drug to achieve goal BP and >1/5th of patients require third drug. Among hypertensive smokers, study participants chose Telmisartan (53%), followed by amlodipine (36%). Dyslipidemia (46%) was most common co-morbid condition seen by Doctors and 70.6% of doctors prescribed Atorvastatin for dyslipidemia. All Doctors opined that patients' awareness to hypertension was poor and counseling of patient's at least once a month was preferred by 92% of doctors. Conclusion: The 'HEART' study data demonstrates that current rates for awareness on hypertension, compliance to treatment is low. Telmisartan is commonly prescribed ARB by Doctors and Dyslipidemia is most common co-morbid condition witnessed in their practice. Increasing number of patients requires >1 drug for achieving goal BP. Emphasis on regular patient counseling on lifestyle modification, medication adherence and follow-up helps in better management of hypertension.

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Section: Discussionmentioning

confidence: 99%

Expert Opinion on Hypertension Management: An Indian Observational Study

Shah

Sadananda²,

Makhale³

et al. 2017

IAM

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“…However, on the basis of the limited information available regarding the effect of higher doses of atorvastatin, our results are broadly similar with the findings of the Cochrane systematic review published in 2012. 187 Having confirmed the Cochrane estimates, we therefore used them for economic modelling (see Chapter 7).…”

Section: Discussionmentioning

confidence: 99%

“…The Cochrane systematic review examining the lipid-lowering efficacy of atorvastatin 187 estimated effects for different doses and modelled the dose-effect relationship. A comparison between these estimates and the ones obtained in the present chapter can be seen in Figure 20 for TC and LDL cholesterol.…”

Section: Meta-analysis Of the Effect Of Atorvastatin On Serum Lipid Lmentioning

confidence: 99%

“…However, the findings in Chapter 3 are broadly consistent with the dose-response equations reported in the 2012 Cochrane Systematic Review. 187 We therefore model the statin effects in our model on these (see equations 7-9, below), obtaining the percentage reductions in TC and LDL shown in Table 47.…”

Section: Treatment Effects Of Statinsmentioning

confidence: 99%

“…However, a number of other systematic reviews addressing this specific research question were published recently; of particular relevance are a Cochrane review examining the dose-related effect of atorvastatin on lipid levels in 254 trials 187 and a systematic review and network meta-analysis evaluating the dose-related effects of different statins on lipid levels in 181 RCTs. 188 Both of these reviews could provide the information required to inform economic analyses of the effect of atorvastatin in lipid monitoring; however, a number of included trials were very small and of short duration, and, if these were excluded, results may differ.…”

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confidence: 99%

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Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling

Perera

McFadden

McLellan

et al. 2015

Health Technol Assess

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BackgroundVarious lipid measurements in monitoring/screening programmes can be used, alone or in cardiovascular risk scores, to guide treatment for prevention of cardiovascular disease (CVD). Because some changes in lipids are due to variability rather than true change, the value of lipid-monitoring strategies needs evaluation.ObjectiveTo determine clinical value and cost-effectiveness of different monitoring intervals and different lipid measures for primary and secondary prevention of CVD.Data sourcesWe searched databases and clinical trials registers from 2007 (including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the Clinical Trials Register, the Current Controlled Trials register, and the Cumulative Index to Nursing and Allied Health Literature) to update and extend previous systematic reviews. Patient-level data from the Clinical Practice Research Datalink and St Luke’s Hospital, Japan, were used in statistical modelling. Utilities and health-care costs were drawn from the literature.MethodsIn two meta-analyses, we used prospective studies to examine associations of lipids with CVD and mortality, and randomised controlled trials to estimate lipid-lowering effects of atorvastatin doses. Patient-level data were used to estimate progression and variability of lipid measurements over time, and hence to model lipid-monitoring strategies. Results are expressed as rates of true-/false-positive and true-/false-negative tests for high lipid or high CVD risk. We estimated incremental costs per quality-adjusted life-year.ResultsA total of 115 publications reported strength of association between different lipid measures and CVD events in 138 data sets. The summary adjusted hazard ratio per standard deviation of total cholesterol (TC) to high-density lipoprotein (HDL) cholesterol ratio was 1.25 (95% confidence interval 1.15 to 1.35) for CVD in a primary prevention population but heterogeneity was high (I2 = 98%); similar results were observed for non-HDL cholesterol, apolipoprotein B and other ratio measures. Associations were smaller for other single lipid measures. Across 10 trials, low-dose atorvastatin (10 and 20 mg) effects ranged from a TC reduction of 0.92 mmol/l to 2.07 mmol/l, and low-density lipoprotein reduction of between 0.88 mmol/l and 1.86 mmol/l. Effects of 40 mg and 80 mg were reported by one trial each. For primary prevention, over a 3-year period, we estimate annual monitoring would unnecessarily treat 9 per 1000 more men (28 vs. 19 per 1000) and 5 per 1000 more women (17 vs. 12 per 1000) than monitoring every 3 years. However, annual monitoring would also undertreat 9 per 1000 fewer men (7 vs. 16 per 1000) and 4 per 1000 fewer women (7 vs. 11 per 1000) than monitoring at 3-year intervals. For secondary prevention, over a 3-year period, annual monitoring would increase unnecessary treatment changes by 66 per 1000 men and 31 per 1000 women, and decrease undertreatment by 29 per 1000 men and 28 per 1000 men, compared with monitoring every 3 years. In cost-effectiveness, strategies with increased screening/monitoring dominate. Exploratory analyses found that any unknown harms of statins would need utility decrements as large as 0.08 (men) to 0.11 (women) per statin user to reverse this finding in primary prevention.LimitationHeterogeneity in meta-analyses.ConclusionsWhile acknowledging known and potential unknown harms of statins, we find that more frequent monitoring strategies are cost-effective compared with others. Regular lipid monitoring in those with and without CVD is likely to be beneficial to patients and to the health service. Future research should include trials of the benefits and harms of atorvastatin 40 and 80 mg, large-scale surveillance of statin safety, and investigation of the effect of monitoring on medication adherence.Study registrationThis study is registered as PROSPERO CRD42013003727.FundingThe National Institute for Health Research Health Technology Assessment programme.

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