A retrospective study of statin use and its effectiveness in Taiwanese

Background: Epidemiological and clinical studies have clearly established the link between low-density lipoprotein cholesterol (LDL-C) and atherosclerosis-related cardiovascular consequences. All treatment guidelines developed in different countries identify LDL-C as a causative factor for cardiovascular disease and as a target for lipid-lowering therapy. Although it has been a common practice for physicians to prescribe statins for patients with dyslipidemia, there is little data regarding the effectiveness of statin therapy in Taiwanese. At the same time, the pattern of statin prescription by Taiwanese physicians has been obscure. Methods: We conducted a retrospective study of dyslipidemic Taiwanese patients receiving statin treatment between Sep. 2002 and Dec. 2004. Clinical information and laboratory parameters were collected by reviewing the medical records. The objective was to evaluate the performance of lipid-lowering therapies with statins. Results: A total of 961 dyslipidemic patients receiving steady dose of statins were selected from 6468 patients. The most commonly prescribed statin was simvastatin (31.8%, n = 306), and the most commonly used doses of different statins were medium potency such as atorvastatin 10 mg (93.4%), fluvastatin 80 mg (96.7%), lovostatin 20 mg (96.7%), pravastatin 10 mg (84.1%) and simvastatin 20 mg (84.3%). Among the five statins examined, atorvastatin appeared to be the most effective in terms of lowering LDL-C levels across all CHD risk groups. The proportion of attainment of guideline treatment goal was inversely related to cardiovascular risk, with less likelihood in the high cardiovascular group. Only 13.5% and 31% of high-risk patients attained the treatment goals for total cholesterol and LDL-C level, respectively. Conclusion: From this retrospective review, we conclude that despite the proven efficacy of statin in lipid-lowering therapy, there are still many patients not achieving their recommended LDL-C target levels. The percentage of successful lipid-lowering is lowest among the patients with highest risk (those with established cardiovascular disease or diabetes patients). There exists a big discrepancy between physicians' perception and the true rate of successful lipid control in Taiwan.