Poor Statin Response May Indicate More Blocked Arteries
Patients whose LDL cholesterol levels worsen or don’t change at all after initiating statin therapy may have more blocked arteries than those whose levels decrease in response to treatment, according to a new study in the journal Arteriosclerosis, Thrombosis and Vascular Biology.
“We observed that nearly 1 in 5 patients treated with a statin have minimal LDL lowering and this associates with more plaque progression, which we know associates with more clinical events,” says principal investigator Stephen Nicholls, MBBS, PhD, deputy director of the South Australian Health & Medical Research Institute and professor of cardiology at the University of Adelaide in Australia.
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“A lot of this is likely to be driven by using suboptimal statin dose, but it also tells us we are going to need other lipid-lowering approaches to complement statin therapy in our patients,” he says. “Monitoring cholesterol levels will continue to be very helpful.”
Nicholls and his colleagues analyzed data from 647 patients with diagnosed coronary artery disease (CAD) who were prescribed statins to help lower their cholesterol. The patients were followed for 18 to 24 months and underwent intravascular ultrasounds to measure the levels of blockage in the diseased arteries before and after statin treatment.
The researchers defined “responders” as those whose LDL levels dropped <15%. “Hyporesponders” either saw a very small decrease, no change, or an increase in LDL levels. These hyporesponders—about 20% of the patients—showed more plaque buildup in their arteries than those who had responded to the statins.
“Some of this represents too many patients with CAD continuing to be treated with low-dose statin therapy. The guidelines very much recommend use of higher-intensity statin therapy in these patients,” Nicholls explains. “We also know there is always variability in terms of drug response between patients.”
Compared to those who responded well to treatment, the hyporesponders tended to be younger (55 vs. 57 years), were more likely to be male (79% vs. 66%) and obese, and were less likely to have a history of dyslipidemia (50% vs. 66%).
“For most individuals, the majority of a statin effect will be observed within the first 2 to 4 weeks of therapy with a particular dose,” Nicholls says. “It would seem reasonable to continue to monitor cholesterol levels after that time period to continue to inform decision making.”
He and his colleagues plan to continue their research to understand how statins work, how to more effectively use established therapies in clinical practice, and to develop and evaluate novel approaches to lipid-lowering that will complement statin therapy.
—Colleen Mullarkey
Reference
1. Kataoka Y, St. John J, Wolski K, Uno K, Puri R, Tuzcu EM, et al. Atheroma progression in hyporesponders to statin therapy. Arterioscler Thromb Vasc Biol. 2015 February 26. [Epub ahead of print].