Comparative analysis of lipid profile management in ischaemic heart disease

Abstract

The European Society of Cardiology (ESC) guidelines for management of dyslipidaemias recommend a target low density lipoprotein cholesterol (LDL-C) goal of ≤1.4 mmol/L or ≥50% relative reduction. Patients with documented cardiovascular disease and elevated individual risk factors are candidates for early intervention with high-intensity statins. The aim of this study was to compare effectiveness and safety of statins in patients with ischaemic heart disease (IHD). Patients diagnosed with IHD and receiving statin therapy were recruited from the Cardiology Department at Mater Dei Hospital and matched for age, gender, hypertension and diabetes mellitus. LDL-C levels and side-effects at the time of recruitment (t1), 6 months (t2) and 12 months (t3) were documented. Mean LDL-C level and percentage LDL-C reduction achieved with different statins was analysed. Eighty-one patients (62 male, 19 female, mean age 68 years, 42 with previous revascularisation) were recruited and followed-up for one year. Statin therapy prescribed included atorvastatin (n=39), simvastatin (n=34), and rosuvastatin (n=8). By t3, 17 patients were switched to a higher intensity statin (atorvastatin 80mg or rosuvastatin 20-40mg) and 4 patients underwent dose intensification. LDL-C reduction observed was similar for those with changed and unchanged statin status (p>0.05). The greatest mean LDL-C reduction was achieved with atorvastatin 80mg: LDL-C score 1.56 mmol/L and 32% reduction from t1. Patients on rosuvastatin achieved a greater percentage LDL-C reduction from t1 (24%) compared to simvastatin (2%) (p<0.001). At t3, 24 patients achieved the 1.4 mmol/L target goal and 12 patients achieved ≥50% relative reduction with high-intensity statins. Eleven cases of myalgia were reported; simvastatin (n=9) and rosuvastatin (n=2). Renal dysfunction was recorded in patients on atorvastatin (n=7) and simvastatin (n=3). Three cases of deranged liver function tests were documented with simvastatin. The high-intensity statins atorvastatin 80mg and rosuvastatin 20-40mg were associated with the greatest LDL-C reduction from baseline. The overall LDL-C levels achieved with statin therapy after 12 months were significantly higher than 1.4 mmol/L. A more intensive LDL-C lowering regime is required to attain targets recommended in ESC guidelines and to reduce cardiovascular risk.