Effect of individualizing starting doses of a statin according to baseline LDL-cholesterol levels on achieving cholesterol targets: the achieve cholesterol targets fast with atorvastatin stratified titration (ACTFAST) study

Atherosclerosis. 2007 Mar;191(1):135-46. doi: 10.1016/j.atherosclerosis.2006.03.019. Epub 2006 Apr 27.

Abstract

Aims: To investigate whether selecting the starting dose of atorvastatin according to baseline and target (<2.6 mmol/L) LDL-cholesterol (LDL-C) values would allow high-risk subjects to achieve target LDL-C concentration within 12 weeks, with the initial dose or a single uptitration.

Methods and results: Twelve-week, prospective, open-label trial that enrolled 2117 high-risk subjects (statin-free [SF] or statin-treated [ST]). Subjects with LDL-C >2.6 mmol/L (100mg/dL) but <or=5.7 mmol/L (220 mg/dL) were assigned a starting dose of atorvastatin (10, 20, 40 or 80 mg/day) based on LDL-C and status of statin use at baseline, with a single uptitration at 6 weeks, if required. There was no washout for ST subjects. At study end, 80% of SF (82%, 82%, 83% and 72% with 10, 20, 40 and 80 mg, respectively) and 59% of ST (60%, 61% and 51% with 20, 40 and 80 mg, respectively) subjects reached LDL-C target. In the ST group, an additional 21-41% reduction in LDL-C was observed over the statin used at baseline. Atorvastatin was well tolerated.

Conclusion: This study confirms that individualizing the starting dose of atorvastatin according to baseline and target LDL-C values (i.e. the required LDL-C reduction), allows a large majority of high-risk subjects to achieve target safely, within 12 weeks, with the initial dose or with a single titration.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anticholesteremic Agents / administration & dosage*
  • Atorvastatin
  • Cholesterol, LDL / blood*
  • Dose-Response Relationship, Drug
  • Female
  • Heptanoic Acids / administration & dosage*
  • Humans
  • Hypercholesterolemia / drug therapy*
  • Male
  • Middle Aged
  • Pyrroles / administration & dosage*
  • Risk Factors
  • Treatment Outcome

Substances

  • Anticholesteremic Agents
  • Cholesterol, LDL
  • Heptanoic Acids
  • Pyrroles
  • Atorvastatin