Achievement of LDL-C goals depends on baseline LDL-C and choice and dose of statin: An analysis from the VOYAGER database

Abstract

BACKGROUND Reducing low-density lipoprotein cholesterol (LDL-C) levels decreases cardiovascular risk in direct proportion to the decrease in LDL-C. DESIGN The aim of this study was to assess the importance of baseline LDL-C and choice and dose of statin in achievement of LDL-C goals of 100 and 70 mg/dl, using a novel statistical model. The analysis included 30,102 patient exposures to rosuvastatin 10–40 mg or atorvastatin 10–80 mg from 31 direct comparative trials in the VOYAGER database. METHODS For each statin dose, percentage goal achievement was plotted for 20 equally large subgroups defined by baseline LDL-C. Logistic regression analysis was then performed for each statin dose to estimate the percentage of patients reaching target. Best-fit logistic regression curves were plotted ‘pair-wise’, comparing each rosuvastatin dose with equal or higher doses of atorvastatin. RESULTS LDL-C <100 mg/dl was achieved by 53.7–85.5% of patients on rosuvastatin 10–40 mg and 43.3–80.0% of those on atorvastatin 10–80 mg, whereas LDL-C <70 mg/dl was achieved by 4.5–44.0% of rosuvastatin-treated patients and 6.5–41.4% of those on atorvastatin. Similar differences in efficacy favouring rosuvastatin over equal or double doses of atorvastatin were observed across the range of baseline LDL-C levels for both LDL-C goals, being more pronounced at higher baseline values. CONCLUSIONS Baseline LDL-C and choice and dose of statin are important for LDL-C goal achievement. The present analysis may allow prediction of individual patient response to different statins at different doses.