Treat to target benefits no one

Donner-Banzhoff and Sönnichsen highlight the lack of evidence for “treating to target” with statins.¹ Treatment targets can lead to an escalation of treatment that is not evidence based, drain clinical resources through repeat clinic visits and blood tests, and can lead to the unnecessary use of branded statins, which bring no additional benefit to the patient and are at least 13 times more expensive than generic statins.²

However, Donner-Banzhoff and Sönnichsen have oversimplified the Scottish Intercollegiate Guidelines Network (SIGN) advice on statins. The SIGN guideline differs from other guidance in the United Kingdom: it does not recommend treatment targets for statins in primary prevention of cardiovascular disease.³ It uses the findings of Hayward’s exploration of statin treatment targets⁴ to note that current clinical evidence does not show that lipid treatment should be titrated to achieve proposed low density lipoprotein (LDL) cholesterol targets. The only treatment target mentioned in the SIGN guideline relates to secondary prevention of cardiovascular disease, and this seems to have been a compromise in response to the targets set in the quality and outcomes framework (QOF). Accordingly, the QOF should move away from setting treatment targets for statins. One alternative would be a QOF target for compliance with statin treatment.