Tailoring treatment to a person’s overall, individual heart attack risk was more effective in preventing heart attack, stroke, and cardiovascular death than current strategies to drive down cholesterol to a target based on National Cholesterol Education Program (NCEP) III guidelines.
“Results were robust, even with assumptions favoring a treat-to-target approach,” observed investigators after examining how a tailored treatment approach to statin therapy compared with treating a patient with medication until target lipid levels were reached (Ann Intern Med. 2010;152:69-77).
The study reviewed 15 years’ worth of statin trials as well as other CAD risk factor data for people aged 30 to 75 years who had never had a heart attack. Five years of treatment tailored to such factors as age, family history, high BP, high C-reactive protein levels, presence of diabetes, and smoking status showed more benefit per person treated and prevented substantially more heart attacks, strokes, and cardiovascular deaths than the currently recommended treat-to-target approaches. For example, the tailored treatment approach was predicted to save 520,000 more quality-adjusted life-years than an intensive NCEP III treat-to-target approach per five years of treatment.
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“The benefits of tailored treatment result from targeting high-risk patients better and basing intensification decisions on a person’s estimated treatment benefit rather than concentrating on whether a desired treatment target has been reached,” explained Rodney A. Hayward, MD.
In a separate statement, Dr. Hayward noted that a person’s risk of heart attack or stroke without treatment, the degree to which a statin decreases that risk, and potential harms from therapy are the three factors that determine the net benefit of a treatment. “Our fixation on just one factor—LDL cholesterol—is leading us to often treat the wrong people,” he cautioned. n
