Real-world variability and factors associated with individual low-density-lipoprotein cholesterol response to different doses of atorvastatin, rosuvastatin, and simvastatin in 28,647 Chinese patients

BACKGROUND AND AIMS: Clinical guidelines recommend statin intensities based on average low-density lipoprotein cholesterol (LDL-C) lowering in clinical trials, but individual response in routine care, especially among non-White patients, is not well described. We therefore aimed to quantify individual LDL-C response and variability of statins in real-world practice in Hong Kong Chinese. METHODS: This cohort study included 28,647 incident statin users (2004-2019) with or without cardiovascular diseases from Hong Kong's public healthcare system. Absolute and percentage changes in LDL-C at one year were assessed by statin type and daily dose (1-<10, 10-<20, 20-80 mg). Generalized estimating equations were used to identify predictors of individual LDL-C response in mmol/L. RESULTS: Despite a modest dose-response trend in absolute LDL-C reduction, interindividual variability was profound, from >80% reductions to >200% increases on the same statin and dose. Across all statin types and dose groups, over 30% of patients exhibited a suboptimal LDL-C response, while each group also included individuals achieving reductions of at least 50%. Greater LDL-C response was associated with more potent statin, higher statin dose, men, older age, chronic kidney disease, diabetes, and higher baseline LDL-C. CONCLUSIONS: This study demonstrates a discordance between the fixed statin intensities recommended in clinical guidelines and the high interindividual variability observed in clinical practice. While low-dose statin initiation is effective at the population level in Hong Kong, variability in LDL-C response supports personalized statin dosing and follow-up monitoring of LDL-C.