Use of Moderate‐Intensity Statins for Low‐Density Lipoprotein Cholesterol Level above 190 mg/dL at Baseline in Koreans

Abstract

The ACC/AHA 2013 guideline recommends high-intensity statin therapy for a decrease in low-density lipoprotein cholesterol (LDL-C) level by >50% among patients with baseline values of ≥190 mg/dL (approximately 4.872 mmol/L); however, this value should be modified before applying it to Korean populations. We investigated the statin-specific LDL-C-lowering effects in Korean patients with baseline LDL-C value ≥4.872 mmol/L. Data of patients prescribed a statin for the first time from January 2009 to December 2013 were assessed. In patients with baseline LDL-C value ≥4.872 mmol/L, laboratory data for a maximum of 6 months from the date of first statin prescription were collected. Among 33,721 patients who were prescribed a statin for the first time, 655 patients had a baseline LDL-C value ≥4.872 mmol/L (1.9%). Of these, 179 patients were analysed. Patients receiving moderate-intensity statins were divided into two groups based on LDL-C reduction rate (p = 0.0002), defined as moderate-high-intensity (atorvastatin 20 mg, rosuvastatin 10 mg, simvastatin 20 mg) and moderate-low-intensity (atorvastatin 10 mg, pitavastatin 2 mg, pravastatin 40 mg) statin groups. LDL-C reduction rates did not significantly differ between the moderate-high- and high-intensity statin groups (p = 0.4895). We found that some moderate-intensity statins demonstrated a LDL-C-lowering effect of more than 50% in Korean patients with a baseline LDL-C value ≥4.872 mmol/L. Our results reflect the need of a large-scale, randomized, controlled trial on partial reclassification of statins for patients with baseline LDL-C value ≥4.872 mmol/L before adopting ACC/AHC guidelines in Korea.

Comparative Effectiveness of Combination Therapy with Statins and Angiotensin‐Converting Enzyme Inhibitors versus Angiotensin II Receptor Blockers in Patients with Coronary Heart Disease: A Nationwide Population‐Based Cohort Study in Korea

“…This result seems acceptable because Asians achieve similar benefits as Westerners at lower statin doses . Furthermore, moderate‐intensity statins have demonstrated a low‐density lipoprotein cholesterol (LDL‐C)‐lowering effect of more than a 50% reduction in Korean patients with baseline LDL‐C levels above 190 mg/dl . According to the 2013 ACC/AHA guideline definitions, these patients received high‐intensity statins because high‐intensity statin therapy was defined as statins lowering LDL‐C levels by ~50% or more.…”

“…35 Furthermore, moderate-intensity statins have demonstrated a low-density lipoprotein cholesterol (LDL-C)-lowering effect of more than a 50% reduction in Korean patients with baseline LDL-C levels above 190 mg/dl. [36][37][38] According to the 2013 ACC/ AHA guideline definitions, 26 these patients received high-intensity statins because highintensity statin therapy was defined as statins lowering LDL-C levels by~50% or more. Due to these intensity disparities, recommendations from the ACC/AHA guidelines should be carefully interpreted when applying them to Asian patients.…”

Phenotyping of Korean patients with better-than-expected efficacy of moderate-intensity statins using tensor factorization

“…However, this guideline is not suitable for Korean and Asian patients [ 7 , 8 ] because it is based on studies that were conducted in limited Asian populations. For example, according to a previous study [ 8 ], some moderate-intensity statins are sufficient for lowering LDL-C levels in Korean patients.…”

“…However, this guideline is not suitable for Korean and Asian patients [ 7 , 8 ] because it is based on studies that were conducted in limited Asian populations. For example, according to a previous study [ 8 ], some moderate-intensity statins are sufficient for lowering LDL-C levels in Korean patients. Although taking high-intensity statin therapy such as atorvastatin (40∼80 mg) and rosuvastatin (20∼40 mg) is recommended to reduce the LDL-C levels by more than 50 percent according to the ACC/AHC guideline [ 6 ], some moderate-intensity statins can replace these high-intensity statins in Korean patients with LDL-C levels ≥190 mg/dl [ 8 ].…”

“…For example, according to a previous study [ 8 ], some moderate-intensity statins are sufficient for lowering LDL-C levels in Korean patients. Although taking high-intensity statin therapy such as atorvastatin (40∼80 mg) and rosuvastatin (20∼40 mg) is recommended to reduce the LDL-C levels by more than 50 percent according to the ACC/AHC guideline [ 6 ], some moderate-intensity statins can replace these high-intensity statins in Korean patients with LDL-C levels ≥190 mg/dl [ 8 ]. Moreover, in previous studies [ 7 , 9 ], statins were classified as high-intensity statins, moderate-to-high-intensity statins, moderate-to-low-intensity statins and low-intensity statins for Korean patients.…”