Ducobu Jean, Claeys Marc, Commers Kathleen, Van Mieghem W, Nachtergaele H, Vandenbroucke M, Deforce J
C.H.U. Tivoli, La Louvière, Belgium.
Curr Med Res Opin. 2007 Aug;23(8):1821-7. doi: 10.1185/030079907X210651.
Hypercholesterolaemia is one of the major risk factors for the development of coronary heart disease (CHD). European guidelines emphasize the importance of reducing low-density lipoprotein cholesterol (LDL-C) levels below 115 mg/dL (3.0 mmol/L) in patients with high CHD risk.
The present study evaluates whether selection of the atorvastatin starting dose based on baseline LDL-C levels and previous statin treatment status would result in an achievement of LDL-C targets without the need for up-titration.
A multicentre, prospective, open-label study conducted in Belgium. Patients were at high risk defined as either a history of CHD, another atherosclerotic disease, diabetes mellitus Type 2 or an estimated 10-year CHD risk > 20%. The primary endpoint was the proportion of patients achieving the LDL-C goal after 12 weeks of treatment.
Overall, 96.4% of the 195 statin-naïve patients reached the LDL-C target after 12 weeks of treatment. The majority of the patients (95.4%) already reached LDL-C control at Week 6. Mean (SD) LDL-C levels decreased from 159 (25) mg/dL[(4.1 (0.6) mmol/L] to 86 (14) mg/dL [2.2 (0.4) mmol/L] after 12 weeks of treatment. Only 4.6% of the patients needed an up-titration at Week 6.
Taken together, the results demonstrate that LDL-C based dose selection of atorvastatin is highly efficacious for rapid achievement of target LDL-C levels with a low need for up-titration. Application of this flexible first dosing strategy in general practice will, based on available evidence, increase adherence to atorvastatin treatment in patients with high CHD risk.
高胆固醇血症是冠心病（CHD）发生的主要危险因素之一。欧洲指南强调，对于冠心病高危患者，将低密度脂蛋白胆固醇（LDL-C）水平降至115mg/dL（3.0mmol/L）以下的重要性。
本研究评估根据基线LDL-C水平和既往他汀类药物治疗情况选择阿托伐他汀起始剂量是否能在无需上调剂量的情况下实现LDL-C目标。
在比利时进行的一项多中心、前瞻性、开放标签研究。患者为高危人群，定义为有冠心病病史、其他动脉粥样硬化疾病、2型糖尿病或估计10年冠心病风险>20%。主要终点是治疗12周后达到LDL-C目标的患者比例。
总体而言，195例初治他汀类药物患者中，96.4%在治疗12周后达到LDL-C目标。大多数患者（95.4%）在第6周时已达到LDL-C控制。治疗12周后，平均（标准差）LDL-C水平从159（25）mg/dL[（4.1（0.6）mmol/L]降至86（14）mg/dL[2.2（0.4）mmol/L]。只有4.6%的患者在第6周需要上调剂量。
综上所述，结果表明基于LDL-C的阿托伐他汀剂量选择对于快速实现目标LDL-C水平非常有效，且上调剂量的需求较低。根据现有证据，在一般实践中应用这种灵活的首次给药策略将增加冠心病高危患者对阿托伐他汀治疗的依从性。
