Over half of patients taking statins for primary prevention do not achieve guideline recommended LDL cholesterol levels two years after starting treatment, new research shows.

A UK prospective cohort study involving over 165, 411 patients also found that 84,609 (51.2%) had a ‘sub-optimal’ (<40% reduction in baseline LDL-C within 24 months) response to statin therapy.

Poor responders to statins also appeared to have a higher cardiovascular risk. The incidence and risk of future cardiovascular events was significantly greater in those with a sub-optimal response to statins, even when accounting for age and baseline LDL cholesterol levels.

For example, during 1,077,299 person-years of follow-up there were 22,798 cardiovascular events; 12,142 in sub-optimal responders and 10,656 in optimal responders.

According to the authors their findings “contribute to the debate on the effectiveness of statin therapy and highlight the need for personalised medicine in lipid management for patients.”

Lead researcher Dr Stephen Weng from Nottingham University in the UK and colleagues noted that there was currently no management strategy in clinical practice that took into account patient variations in LDL-C response, and no guidelines for predictive screening before starting statin therapy.

“Validated clinical decision tools which can predict cholesterol response to statins, or to non-statin drugs, with interventions to help clinicians to tailor and optimise statin treatments for individual patients are needed,” they concluded in their paper published in Heart.

An accompanying editorial said the study results gave a clear message to clinicians and patients on the importance of LDL-C lowering for primary prevention of atherosclerotic heart disease.

Clinicians should also use their judgement to “refine statin therapy beyond general guideline recommendations on a case-by-case basis in their practice, though one should always consider the incremental benefit of more aggressive statin use,” it advised