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The importance of considering LDL cholesterol response as well as cardiovascular risk in deciding who can benefit from statin therapy

Soran, Handreana,b; Schofield, Jonathan D.a,b; Durrington, Paul N.a

doi: 10.1097/MOL.0000000000000097
HYPERLIPIDAEMIA AND CARDIOVASCULAR DISEASE: Edited by Paul N. Durrington

Purpose of review: Guidelines seeking to deploy statin treatment rely heavily on the use of estimates of absolute cardiovascular disease (CVD) risk as an arbiter of who should receive statins. We question whether this is an effective strategy unless the LDL-cholesterol (LDL-C) response is also considered.

Recent findings: Recently, meta-analyses of randomized clinical trials of statins have revealed that CVD risk decreases linearly by 22% for each 1 mmol/l reduction in LDL-C. Calculation of the number needed to treat with statins to prevent one CVD event using both the pretreatment absolute CVD risk and the LDL-C response that can be achieved is thus possible. Application of this evidence reveals that many people (including younger ones) with high LDL-C levels can benefit more than people currently receiving statin treatment solely on the basis of their absolute CVD risk, whereas others at higher CVD risk, but with lower LDL-C, will derive little benefit. This does not seem to have been adequately considered in recent clinical guidelines.

Summary: A simple additional mathematical step in risk assessment to take account of the LDL-C response to statins and provide knowledge of number needed to treat would greatly improve individual management, cost-effectiveness and the population impact of statins.

aCardiovascular Research Group, School of Biomedicine, University of Manchester,

bCardiovascular Trials Unit, University Department of Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK

Correspondence to Professor Paul N. Durrington Cardiovascular Research Group, School of Biomedicine, Core Technology Facility (3rd Floor), University of Manchester, 46 Grafton Street, ManchesterM13 9NT, UK. Tel: +44 161 275 1201; fax: +44 161 275 1183; e-mail: pdurrington@manchester.ac.uk

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