October 24, 2012
Intensive Monotherapy With Certain Statins Most Effective
Corvallis, OR—Just increasing the dosage of statins, instead of using other drugs or combinations of drugs, often offers the best protection against serious cardiovascular problems in patients with dyslipidemia, according to a comprehensive review on treating high cholesterol and other blood lipid problems.
“Statins are proven medications that can reduce heart attacks and strokes by about 30% in the patients that need them,” said Matthew K. Ito, PharmD, a professor of pharmacy practice at Oregon State University, author of the study and president-elect of the National Lipid Association. “What we looked at here was whether adding other drugs or therapies to the use of statins could further reduce problems, and in most cases the research indicates that they didn't help. What did help was increasing the statin dose to higher levels within the range for which they are approved. And there did not appear to be a significant change in side effects based on any approved dosage."
The review, published recently in the Annals of Pharmacotherapy, suggested, however, that some statins work better at higher doses than others. For intensive monotherapy with an average patient, the review found that only two of the most commonly prescribed statins are suitable: atorvastatin and rosuvastatin. “Not suitable for intensive monotherapy,” according to the review, are fluvastatin, lovastatin, pitavastatin, pravastatin, and simvastatin.
In general, the review noted, the use of statins is appropriate for both moderate- and high-risk patients who have issues with their cholesterol levels, or may already have experienced a heart attack or angina as a result of cardiovascular disease. The goal of intensive monotherapy usually is to reduce LDL cholesterol to 100 mg/dL or less—or 70 mg/dL or less for people who already have coronary disease, diabetes or other special risks. If that cannot be achieved, the medication goal should be to at least cut the LDL level in half, according to Ito.
“The reaction to statin regimens varies with the individual, so some of these other drugs may also be able to accomplish the goals we're seeking,” Ito said. “These recommendations are based on results with an average patient, but physicians may find some of their patients can do adequately well with other statins, or that they don't need intensive monotherapy.”
Side effects, particularly myopathy, must also be considered, the review noted.
Other medications sometimes given for dyslipidemia were shown to have less value than statins or, in some cases, pose greater risks, the review found. Among those are fibrates to lower triglyceride levels, niacin to lower triglycerides and raise HDL levels, and omega-3 fatty acids.
“We found that only in patients with extremely high triglycerides and very low HDL would use of fibrates be appropriate to use in addition to statins,” Ito said. “Otherwise the increased risks outweigh the benefits, especially in women.”
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