The Pharmaceutical Journal
Vol 270 No 7243 p463
5 April 2003

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Target cholesterol values of <=5mmol/L are unrealistic

Target serum cholesterol values of 5mmol/L or less may be unrealistic even for patients on the most efficacious lipid-lowering drugs, according to researchers from the Nottingham University.

They compared the effectiveness of individual lipid-lowering drugs in lowering serum cholesterol concentration outside a clinical trial setting. Data were analysed for patients aged 35 years or over, from 17 general practices in 17 primary care groups, who were receiving lipid-lowering treatment and who had at least two serum cholesterol levels recorded.

Initial (pretreatment) serum cholesterol concentrations in a primary care setting were higher than those reported in randomised controlled trials. The researchers say that this may partly explain the high proportion of patients who fail to achieve targets set in guidelines because a greater absolute reduction is needed to achieve the target value of <=5mmol/L. The higher initial concentrations could also mean that absolute reduction in cardiovascular risk in primary care patients may be greater than previously thought.

The researchers did find that statins produce similar percentage reductions in serum cholesterol concentrations in a primary care setting as in randomised controlled clinical trials. As in clinical trials, the ability of individual statins to lower serum cholesterol concentration varied in the primary care setting, with atorvastatin and simvastatin being the most effective.

However, the researchers conclude that their data “show that there is still room for improvement in the overall management of hyperlipidaemia in primary care” (BMJ 2003;326:689).