Monday, February 27, 2006

Targeted statin therapy versus usual care: The ALLIANCE trial

Recently published in the American Journal of Medicine, the study compared a formal strategy of treating to new aggressive LDL targets (<80 mg/dl) with “usual care.” The formal strategy used atorvastatin in doses up to 80 mg daily and was associated with improved cardiovascular outcomes. It is not clear how many of the usual care patients received statin drugs, but apparently a substantial number. 66% of all patients were on lipid lowering medications at study entry. The usual care group achieved an average post treatment LDLC level of 111 mg/dl as opposed to 95 mg/dl in the formal treatment group. Treatment adjustments in the usual care group were at the discretion of the primary physician, to simulate “real world” conditions.

Usual care in this study, achieving an average LDLC of 111 mg/dl, was surprisingly good. Nevertheless the formal targeted strategy was better. To me this finding speaks strongly for the use of dedicated lipid clinics. I know of no better way to apply these results to community practice. Finally, these results are in marked contrast to the lipid arm of ALLHAT which found pravastatin 40 mg daily to be no better than usual care.

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