Researchers used data submitted by 681 primary care physicians to the UK Clinical Practice Research Datalink. The study group consisted of 165,411 persons who were prescribed a statin between 1990 and 2016 and who had not been treated for heart disease or stroke prior to prescribing.
They defined a "reasonable" response to statin therapy as a reduction in LDL or "bad" cholesterol by 40% or more, as recommended by the UK's National Institute for Health and Care Excellence.
After taking into account the age differences and the underlying medical conditions, the researchers found that individuals who had not adequately lowered their LDL cholesterol levels were 22% more likely to develop cardiovascular disease than people that lowered it.
The number of Americans who do not achieve the targeted cholesterol after starting on a statin is likely to be similar to the results of the study. David Fischman, professor of medicine and co-director of the Cardiac Catheterization Laboratory at Thomas Jefferson University Hospital, who was not involved in the study.
"Taking care of patients, treating them with statins is a job, it's a lot of work, it's not easy, it's time to get it right," Fischman said. "If you give someone a cholesterol medication, you should check your cholesterol in four to twelve weeks and then make adjustments, and this underlines the importance of doing so."
In addition to the amount of work and effort required to optimize cholesterol levels, the authors explain that genetic factors and differences in the level of cholesterol Adherence to Prescribed Therapies may explain some of the variations in the response to statin prescriptions and require a "personalized" medicine.
"There is currently no management strategy in clinical practice that addresses patient variation in the [low density cholesterol] response. There are no guidelines for predictive screening prior to initiation of statin therapy," the researchers said.
The research has several limitations. As an observational study, it can not detect cause and effect. The exact dosage of prescribed statins and patient compliance were not research topics.
"The takeaway message for us is that we have to do a good job, not just the doctor, but also the patient," said Fischman. "Because if we do not, [patients who don’t reach target cholesterol levels] will not do so well."