Details of HTA project in progress
Last updated: 26 August 2008 - Next update due: 2 September 2008
Research type: |
HTA Technology Assessment Report |
Project title: |
Early high dose lipid-lowering therapy to prevent cardiac events |
Project ref: |
07/03/01 |
Cost: |
This project has been commissioned by the HTA programme on a call-off contract basis. |
Chief Investigator : |
School of Health and Related Research (ScHARR-TAG), University of Sheffield |
Start Date: |
January 2008. |
Publication date: |
Mid 2009. This date takes account of time for report preparation and printing based on current average times for these activities. |
Plain English Summary |
Cardiovascular disease (CVD) is a disorder of the heart and blood vessels, which can lead to cardiovascular events such as heart attack (myocardial infarction, MI) and stroke. The most common form of CVD is coronary heart disease (CHD), also known as coronary artery disease and ischaemic heart disease. CHD is caused by the narrowing of the arteries that supply the heart and is due to a gradual build-up of fatty material called atheroma. The narrowing can cause MI, angina (pain or discomfort in the chest or neighbouring parts of the body due to insufficient oxygen reaching the heart) and other forms of chronic heart disease. Angina is usually classified as stable or unstable disease. Other forms of CVD are stroke, transient ischaemic attack (TIA) and peripheral vascular disease (PVD). CVD is the most common cause of death in the UK, accounting for over 208,000 deaths in 2005.1 Approximately 49% of these deaths were from CHD and 28% from stroke. CVD is also a significant cause of morbidity and can have a major impact on quality of life.2 Cholesterol is a key component in the development of atherosclerosis (the accumulation of fatty deposits (atheroma) on the inner lining of the arteries). Mainly as a result of this, cholesterol increases the risk of CVD.3,4 The lowering of cholesterol whether by diet, drugs or other means, decreases CVD risk.5 Statin therapy, associated principally with lowering concentrations of total cholesterol (Total-c) and LDL-c, with smaller effects in raising high-density lipoprotein cholesterol (HDL-c) and decreasing triglyceride levels, can reduce the risk of cardiovascular events, morbidity and mortality.6 Although blood cholesterol is an important risk factor for CVD, cholesterol lowering with drug therapy is only one of a number of methods of reducing the risk.7 Dietary and lifestyle modifications (e.g. weight loss, smoking cessation, aerobic exercise) are an integral part of risk management. If these are unsuccessful and the patient is at high risk, more effective therapy, including lipid regulating drug therapy, is initiated.8 The decision to initiate therapy with a lipid-regulating drug is generally based on an assessment of overall CVD risk. Statins are the current cholesterol-lowering drugs of choice for the long-term management and secondary prevention of CVD.9 While long-term statin therapy reduces CVD events, the early period following an acute coronary syndrome (i.e. MI or unstable angina) or coronary revascularisation (coronary artery bypass grafting, CABG or percutaneous transluminal coronary angioplasty, PTCA) represents a stage where the individual is at highest risk of recurrent cardiovascular events and mortality.10 Meta-analyses of randomised controlled trials (RCTs) have shown that early, intensive (high) dose statin therapy is of benefit in reducing death and cardiovascular events when prescribed immediately after an acute coronary syndrome compared to standard (moderate) statin therapy.11,12 However, in the UK, there is great variation in the prescribing practices (particularly current standard dose) and management of patients with ACS. Some Primary Care Trusts (PCTs) recommend simvastatin 40g as the current standard dose whereas others recommend atorvastatin 80mg/d. Initiation of standard dose would be on the first day of the event and duration is in theory for life. The aim of this review is to systematically evaluate and appraise the potential clinical and cost effectiveness of switching from the current standard dose statin (i.e. simvastatin 40mg/d) to a high dose statin (i.e. simvastatin 80mg/d, atorvastatin 80mg/d or rosuvastatin 40mg/d) in patients who have recently had a myocardial infarction or unstable angina, or who have recently undergone revascularisation and who are currently prescribed simvastatin 40mg/d. |
Abstract: |
The assessment will address the question: Should patients in the UK who have recently had a MI, unstable angina or revascularisation procedure, who are currently using simvastatin 40mg/d switch to higher doses such as simvastatin 80mg/d, atorvastatin 80mg/d or rosuvastatin 40mg/d. The National Co-ordinating Centre for HTA commissioned this technology assessment report on behalf of the HTA Programme Director. |
NRR* number, if applicable: |
(*National Research Register) |
Project Protocol: |
Project protocol (pdf format, 155 kbytes) |
URL of this page: |
http://www.hta.ac.uk/1700 |
News feeds