Efficacy of atorvastatin after LDL-cholesterol-based dose selection in high risk dyslipidaemic patients: results of the target dose study.

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.