Which statin worked best to achieve lipid level targets in a European registry? A post-hoc analysis of the EUROASPIRE III for coronary heart disease patients

Objective: The objective of the study is to determine the proportion of patients within the subsample reaching the target lipid levels defined in the European guidelines, stratified according to type and dose of statin used.

Background: Many factors affect the attainment of lipid level targets including gender, age, compliance, statin type, and dosage. This study aimed to determine the percentage of post-interventional coronary heart disease (CHD) patients who met the lipid level targets recommended by the Joint European Societies Guidelines, the medications used, and their doses.

Methods: A post-hoc analysis of a subsample of 2,000 patients from EUROASPIRE III database was selected randomly from patients who attended the interviews (between six months to three years after event). Further stratification according to type and dose of statin was performed.

Results: The sample comprised 74.5% males, and two thirds (63.8%) of the entire sample were over 60 years of age. More women than men showed elevated total cholesterol (>4.5 mmol/l and >4.0 mmol/l), LDL-cholesterol (>2.5 mmol/l and >2.0 mmol/l), and triglycerides (>1.7 mmol/l). Atorvastatin was the most widely used at both discharge and interview (47.1% and 45.4%) than simvastatin (37.7% and 39.4%). A dose of 20 mg atorvastatin was used by 44.10% of patients, while those on fluvastatin used a higher dose: ⩾40 mg in 88.31%. Patients who achieved targeted total cholesterol levels for atorvastatin, fluvastatin, lovastatin and simvastatin showed a trend in dose increase. Pravastatin users who achieved the target were taking a dose of 10 mg (75%) and less were in the 20 mg group (33.33%). Rosuvastatin users who consumed 10 mg and ⩾40 mg dose achieved the lipid level targets by 61.82% and 66.67%, respectively.

Conclusion: Compliance with medications was high after a CHD incident in this European sample and the increase of the atorvastatin and simvastatin doses enabled the attainment of the target levels recommended.