Achieving cholesterol targets by individualizing starting doses of statin according to baseline low-density lipoprotein cholesterol and coronary artery disease risk category: The CANadians Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (CanACTFAST) study

作者：Ur Ehud; Langer Anatoly; Rabkin Simon W; Calciu Cristina Dana; Leiter Lawrence A^*

来源：Canadian Journal of Cardiology, 2010, 26(2): 80-86.

• Cholesterol
• Coronary artery disease
• Diabetes mellitus
• Dyslipidemias
• Hypercholesterolemia
• Statin

BACKGROUND: Despite an increasing body of evidence on the benefit of lowering elevated levels of low-density lipoprotein cholesterol (LDL-C), there is still considerable concern that patients are not achieving target LDL-C levels.
OBJECTIVE: The CANadians Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (CanACTFAST) trial tested whether an algorithm,based statin dosing approach Would enable patients to achieve LDL-C and total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio targets quickly.
METHODS: Subjects requiring statin therapy, but with,in LDL-C level of 5.7 mmol/L or lower, and triglycerides of 6.8 mmol/L or lower at screening participated in the 12-week study, which had two open-label, six-week phases: a treatment period during which patients received 10 mg, 20 mg, 40 mg or 80 mg of atorvastatin based on an algorithm incorporating baseline LDL-C value and cardiovascular risk; and patients who achieved both LDL-C and TC/HDL-C ratio targets at six weeks continued on the same atorvastatin dose. Patients who did not achieve both targets received dose uptitration using a single-step titration regimen. The primary efficacy outcome was the proportion of patients achieving target LDL-C levels after 12 weeks.
RESULTS: Of 2016 subjects screened at 88 Canadian sites, 1258 were assigned to a Study drug ( 1101 were statin,free and 157 were statin-treated at baseline). The proportion Of Subjects who achieved LDL-C targets after 12 weeks of treatment was 86% (95% CI 84% to 88%) for statin-free patients and 54% (95% CI 46% to 61%) for statin treated patients. Overall, 1003 subjects (80%; 95% CI 78% to 82%) achieved both lipid targets.
CONCLUSIONS: Algorithm-based statin dosing enables patients to achieve LDL,C and TC/HDL-C ratio targets quickly, with either no titration or a single titration.

• 出版日期2010-2