Cross sectional survey of effectiveness of lipid lowering drugs in reducing serum cholesterol concentration in patients in 17 general practices

Objective: To compare the effectiveness of lipid lowering drugs in lowering serum cholesterol concentrations. Design: Cross sectional study. Setting: 17 practices within 17 primary care groups in Trent region, United Kingdom. Participants: Patients aged 35 years or over taking lipid lowering drugs and with at least two serum cholesterol concentrations recorded on computer. Main outcome measures: Proportion of patients achieving serum cholesterol concentration of ≤5 mmol/l and mean percentage reduction in serum cholesterol concentration. Results: 1353 of 2469 (54.8%) patients receiving lipid lowering treatment had a last recorded serum cholesterol concentration of ≤5 mmol/l. Significantly more patients taking statins achieved the target value for serum cholesterol (5 mmol/l) than those taking fibrates (1307 (57%) v 46 (26%); P<0.0001). Atorvastatin and simvastatin were the most effective drugs in achieving the target. Significant differences were found between lipid lowering drugs for the pretreatment serum cholesterol concentration, the most recent cholesterol concentration, and the associated percentage reduction. Atorvastatin and simvastatin achieved the greatest percentage reduction in serum cholesterol concentrations (30.1%, 95% confidence interval 28.8% to 31.4%, and 28.0%, 26.7% to 29.3%, respectively). Although the mean serum cholesterol concentrations in this unselected population tended to be higher than those in clinical trials, the percentage reduction was consistent with the trials. Conclusion: The ability of individual statins to lower serum cholesterol concentration varied, with atorvastatin and simvastatin being the most effective. The percentage reductions agreed with those of randomised controlled trials indicating likely benefits in unselected patients in primary care. As the initial serum cholesterol concentrations were higher than those in randomised controlled trials, target serum cholesterol values of ≤5 mmol/l may be unrealistic even for patients taking the most efficacious drugs. Also, the higher initial levels could mean that the absolute reduction in cardiovascular risk in primary care patients is greater than thought. What is already known on this topic Statins in patients with coronary heart disease help reduce further cardiovascular events and improve survival This seems to be a class effect of statins, although there may be important differences in effectiveness between them Less than half of patients in the community who take lipid lowering drugs achieve target serum cholesterol values What this study adds Statins vary in their ability to lower serum cholesterol concentration, with atorvastatin and simvastatin achieving the best results The percentage reductions agreed with those found in randomised controlled trials Since the initial serum cholesterol concentrations were higher than in trials, absolute risk reductions in primary care patients may be greater than thought Target values of ≤5 mmol/l may be unrealistic even for patients on the most efficacious drugs, because the initial mean cholesterol values of primary care patients are higher than those of patients in trials