Achieving and maintaining National Cholesterol Education Program low-density lipoprotein cholesterol goals with five statins

Thomas C. Andrews, Christie M. Ballantyne, Judith A. Hsia, Jeffrey H. Kramer

Research output: Contribution to journalArticle

157 Citations (Scopus)

Abstract

PURPOSE: Most patients fail to achieve and maintain low-density lipoprotein (LDL) cholesterol goals established by the National Cholesterol Education Program (NCEP). The Atorvastatin Comparative Cholesterol Efficacy and Safety Study (ACCESS) was a randomized study comparing the efficacy and safety of five statins and their ability reduce LDL cholesterol to the NCEP target level. SUBJECTS AND METHODS: Of 7542 patients screened, 3916 hypercholesterolemic patients were randomly assigned to treatment with a statin, beginning with the lowest recommended dose (atorvastatin, pravastatin, and simvastatin, 10 mg; fluvastatin and lovastatin, 20 mg). If the NCEP target was not achieved, the dose was titrated up to the recommended maximum (atorvastatin, fluvastatin, and lovastatin, 80 mg; pravastatin and simvastatin, 40 mg). The total duration of treatment was 54 weeks. RESULTS: Atorvastatin achieved the greatest mean reduction in LDL cholesterol: 36% ± 11% at 6 weeks (initial dose) and 42% ± 13% at 54 weeks. More patients receiving atorvastatin at its initial dose (53%, 997 of 1888) achieved their NCEP target levels than patients receiving simvastatin (38%, 174 of 462), lovastatin (28%, 134 of 472), pravastatin (15%, 71 of 461), or fluvastatin (15%, 69 of 474) at the initial dose. Atorvastatin-treated patients were more likely to maintain their target levels from week 6 to week 54. The percent reduction in LDL cholesterol achieved at the initial dose correlated strongly with the proportion of patients who maintained their goals at 54 weeks (r = -0.84). CONCLUSION: For patients treated with statins, providing a greater margin between the NCEP target level and the achieved LDL cholesterol level enhances the likelihood of maintaining NCEP goal levels.

Original languageEnglish (US)
Pages (from-to)185-191
Number of pages7
JournalAmerican Journal of Medicine
Volume111
Issue number3
DOIs
StatePublished - Aug 15 2001

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
LDL Cholesterol
fluvastatin
Cholesterol
Education
Pravastatin
Lovastatin
Simvastatin
Safety
Atorvastatin Calcium
Therapeutics

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Achieving and maintaining National Cholesterol Education Program low-density lipoprotein cholesterol goals with five statins. / Andrews, Thomas C.; Ballantyne, Christie M.; Hsia, Judith A.; Kramer, Jeffrey H.

In: American Journal of Medicine, Vol. 111, No. 3, 15.08.2001, p. 185-191.

Research output: Contribution to journalArticle

Andrews, Thomas C. ; Ballantyne, Christie M. ; Hsia, Judith A. ; Kramer, Jeffrey H. / Achieving and maintaining National Cholesterol Education Program low-density lipoprotein cholesterol goals with five statins. In: American Journal of Medicine. 2001 ; Vol. 111, No. 3. pp. 185-191.
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abstract = "PURPOSE: Most patients fail to achieve and maintain low-density lipoprotein (LDL) cholesterol goals established by the National Cholesterol Education Program (NCEP). The Atorvastatin Comparative Cholesterol Efficacy and Safety Study (ACCESS) was a randomized study comparing the efficacy and safety of five statins and their ability reduce LDL cholesterol to the NCEP target level. SUBJECTS AND METHODS: Of 7542 patients screened, 3916 hypercholesterolemic patients were randomly assigned to treatment with a statin, beginning with the lowest recommended dose (atorvastatin, pravastatin, and simvastatin, 10 mg; fluvastatin and lovastatin, 20 mg). If the NCEP target was not achieved, the dose was titrated up to the recommended maximum (atorvastatin, fluvastatin, and lovastatin, 80 mg; pravastatin and simvastatin, 40 mg). The total duration of treatment was 54 weeks. RESULTS: Atorvastatin achieved the greatest mean reduction in LDL cholesterol: 36{\%} ± 11{\%} at 6 weeks (initial dose) and 42{\%} ± 13{\%} at 54 weeks. More patients receiving atorvastatin at its initial dose (53{\%}, 997 of 1888) achieved their NCEP target levels than patients receiving simvastatin (38{\%}, 174 of 462), lovastatin (28{\%}, 134 of 472), pravastatin (15{\%}, 71 of 461), or fluvastatin (15{\%}, 69 of 474) at the initial dose. Atorvastatin-treated patients were more likely to maintain their target levels from week 6 to week 54. The percent reduction in LDL cholesterol achieved at the initial dose correlated strongly with the proportion of patients who maintained their goals at 54 weeks (r = -0.84). CONCLUSION: For patients treated with statins, providing a greater margin between the NCEP target level and the achieved LDL cholesterol level enhances the likelihood of maintaining NCEP goal levels.",
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