In recent years the “treat to target” method for giving statins for prevention has gained widespread acceptance among healthcare professionals. Now a new study in the Annals of Internal Medicine finds evidence that an approach using fixed doses of statins based on the risk levels of individual patients might be better.
Rodney Hayward and colleagues estimated the treatment effect of a tailored treatment based on 5 year CAD risk, in which patients with a 5% to 15% risk received simvastatin 40 mg and patients with a CAD risk over 15% received atorvastatin. Compared to treat-to-target approaches from the National Cholesterol Education Program (NCEP) III guidelines, the tailored strategy treated saved 500,000 more quality-adjusted life-years and treated fewer people with high-dose statins.
The authors speculate why a tailored approach may be superior to a treat-to-target approach: “The main reason why treat-to-target strategies fall short arises from a single risk factor (in this case, LDL cholesterol) receiving dramatically more weight than all other predictors of treatment benefit, resulting in other highly relevant information being either ignored or underweighted.”
Furthermore, they write, “the goal behind the treat-to-target approach was a good one—to identify high-risk and high-benefit patients and to treat them more aggressively— but the treat-to-target strategy is an inferior approach for identifying these patients compared with tailored treatment.”
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