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An analysis of cholesterol control and statin use in the Losartan Intervention for Endpoint Reduction in Hypertension
Krister Kristianson1, Frej Fyhrquist, Richard B Devereux
1Merck Research Laboratories Scandinavia, Sollentuna, Sweden. krister_kristianson@merck.com
Insights
Cholesterol control was poor in hypertensive patients despite guidelines recommending aggressive lipid-lowering therapy. Statin use was suboptimal, with most patients failing to reach target cholesterol levels in a long-term cardiovascular trial.
Area of Science:
- Cardiology
- Hypertension Management
- Lipidology
Background:
- Aggressive cholesterol-lowering therapy is recommended for patients with elevated lipids or cardiovascular disease risk factors.
- Optimal treatment adherence and effectiveness in real-world settings remain unclear.
Purpose of the Study:
- To evaluate cholesterol control and statin utilization within a large, long-term cardiovascular end point study.
- Assess adherence to cholesterol management guidelines in hypertensive patients.
Main Methods:
- Analysis of baseline and end-of-study data from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study (1995-2001).
- Inclusion of 8653 hypertensive patients (aged 55-80) with left ventricular hypertrophy.
- Evaluation of total cholesterol (TC) levels against a target of <5.0 mmol/L and assessment of statin use.
Main Results:
- At study end, 21.9% of patients received statins, but 57.9% of these remained above the target TC level.
- Among patients not on statins at study end (78.1%), 78.6% had TC levels above the target.
- Mean TC levels remained elevated, indicating poor cholesterol control despite statin use in some patients.
Conclusions:
- Statin administration was suboptimal in this cohort of hypertensive patients with left ventricular hypertrophy.
- Cholesterol levels were poorly controlled, falling short of recommended treatment targets in a significant proportion of patients.
Background:
There is general agreement that patients who have elevated lipid levels and/or risk factors for or existing cardiovascular disease should receive aggressive cholesterol-lowering therapy. However, it is not clear whether patients are receiving the recommended treatment.
Objective:
This study evaluated cholesterol control and statin use in the setting of a large, long-term cardiovascular end point trial.
Methods:
The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study was conducted between 1995 and 2001 to compare the incidence of cardiovascular morbidity and mortality with losartan- or atenolol-based treatment in 9193 patients aged 55 to 80 years with hypertension and left ventricular hypertrophy. The mean (SD) duration of follow-up was 4.8 (0.9) years. Use of lipid-lowering therapy was at the discretion of the investigator. In the present study, analyses of baseline and end-of-study mean total cholesterol (TC) and high-density lipoprotein cholesterol levels and statin use were performed for the combined treatment groups. Based on generally accepted guidelines, achievement of a TC level <5.0 mmol/L (193.5 mg/dL) was used as the treatment target for the purpose of these analyses. The proportions of patients with TC levels above this cutoff were calculated at baseline and at the final visit.
Results:
A total of 8653 patients had baseline and end-of-study cholesterol measurements and were included in this analysis. At baseline, 528 (6.1%) patients were receiving statins; TC levels were above the cutoff in 381 (72.2%) of these patients, who had a mean TC level of 6.07 mmol/L (234.7 mg/dL). Of 8125 (93.9%) patients who were not receiving statins at baseline, TC levels were above the cutoff in 6859 (84.4%), with a mean TC level of 6.37 mmol/L (246.4 mg/dL). At the end of the study, 1892 (21.9%) patients were receiving a statin; TC levels were above the cutoff in 1096 (57.9%) of these patients, who had a mean TC level of 5.99 mmol/: (231.6 mg/dL). Of 6761 (78.1%) patients who were not receiving statins at the end of the study, TC levels were above the cutoff in 5316 (78.6%), with a mean TC level of 6.24 mmol/L (241.4 mg/dL).
Conclusions:
In this long-term cardiovascular end point study in patients with moderate to severe hypertension and left ventricular hypertrophy, statins were not optimally administered and cholesterol levels were poorly controlled.
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