Tags

Type your tag names separated by a space and hit enter

The statin studies: from targeting hypercholesterolaemia to targeting the high-risk patient.
QJM 2005; 98(8):599-614QJM

Abstract

The landmark HMG-CoA reductase inhibitor (statin) studies have practical lessons for clinicans. The 4S trial established the importance of treating the hypercholesterolaemic patient with cardiovascular heart disease. Next, WOSCOPS showed the benefit of treating healthy, high-risk hypercholesterolaemic men. CARE, a secondary prevention trial, showed the benefit of treating patients with cholesterol levels within normal limits. This was confirmed by the LIPID trial, another secondary prevention study, which enrolled patients with cholesterol levels 155-271 mg/dl (4-7 mmol/l). The importance of treating patients with established ischaemic heart disease, and those at high risk of developing heart disease, regardless of cholesterol level, was being realized. In the MIRACL trial, hypocholesterolaemic therapy was useful in the setting of an acute coronary syndrome, while the AVERT study showed that aggressive statin therapy is as good as angioplasty in reducing ischaemic events in patients with stable angina. By showing the value of fluvastatin after percutaneous intervention, LIPS confirmed that benefit is a class action of the statins. The HPS randomized over 20 000 patients, and showed beyond doubt the value of statins in reducing cardiovascular events in the high-risk patient. Although PROSPER showed benefit in treating the elderly patients above 70 years, statin therapy in this trial was associated with an increase in cancer incidence. The comparative statin trials, PROVE-IT, REVERSAL, Phase Z of the A to Z, ALLIANCE and TNT, all showed that high-dose statins will better reduce cardiovascular events in the high-risk patient, although the adverse effects of therapy will also be increased. ALLHAT-LLT, ASCOT-LLA and CARDS showed that for statin therapy to demonstrate a significant benefit, hypertensive or diabetic patients must be at sufficiently high risk of cardiovascular events. The emphasis is now on the risk level for developing cardiovascular events, and treatment should target the high-risk group and not the lipid level of the patient. No therapy is free of adverse effect. Treatment of those most at risk will bring the most benefit; treatment of those not at high risk of cardiovascular disease may expose patients who would not benefit much from therapy to its adverse effects.

Authors+Show Affiliations

HT Ong Heart Clinic, 251-C Burmah Road, 10350 Penang, Malaysia. htyl@pd.jaring.my

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16006501

Citation

Ong, H T.. "The Statin Studies: From Targeting Hypercholesterolaemia to Targeting the High-risk Patient." QJM : Monthly Journal of the Association of Physicians, vol. 98, no. 8, 2005, pp. 599-614.
Ong HT. The statin studies: from targeting hypercholesterolaemia to targeting the high-risk patient. QJM. 2005;98(8):599-614.
Ong, H. T. (2005). The statin studies: from targeting hypercholesterolaemia to targeting the high-risk patient. QJM : Monthly Journal of the Association of Physicians, 98(8), pp. 599-614.
Ong HT. The Statin Studies: From Targeting Hypercholesterolaemia to Targeting the High-risk Patient. QJM. 2005;98(8):599-614. PubMed PMID: 16006501.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The statin studies: from targeting hypercholesterolaemia to targeting the high-risk patient. A1 - Ong,H T, Y1 - 2005/07/08/ PY - 2005/7/12/pubmed PY - 2005/10/26/medline PY - 2005/7/12/entrez SP - 599 EP - 614 JF - QJM : monthly journal of the Association of Physicians JO - QJM VL - 98 IS - 8 N2 - The landmark HMG-CoA reductase inhibitor (statin) studies have practical lessons for clinicans. The 4S trial established the importance of treating the hypercholesterolaemic patient with cardiovascular heart disease. Next, WOSCOPS showed the benefit of treating healthy, high-risk hypercholesterolaemic men. CARE, a secondary prevention trial, showed the benefit of treating patients with cholesterol levels within normal limits. This was confirmed by the LIPID trial, another secondary prevention study, which enrolled patients with cholesterol levels 155-271 mg/dl (4-7 mmol/l). The importance of treating patients with established ischaemic heart disease, and those at high risk of developing heart disease, regardless of cholesterol level, was being realized. In the MIRACL trial, hypocholesterolaemic therapy was useful in the setting of an acute coronary syndrome, while the AVERT study showed that aggressive statin therapy is as good as angioplasty in reducing ischaemic events in patients with stable angina. By showing the value of fluvastatin after percutaneous intervention, LIPS confirmed that benefit is a class action of the statins. The HPS randomized over 20 000 patients, and showed beyond doubt the value of statins in reducing cardiovascular events in the high-risk patient. Although PROSPER showed benefit in treating the elderly patients above 70 years, statin therapy in this trial was associated with an increase in cancer incidence. The comparative statin trials, PROVE-IT, REVERSAL, Phase Z of the A to Z, ALLIANCE and TNT, all showed that high-dose statins will better reduce cardiovascular events in the high-risk patient, although the adverse effects of therapy will also be increased. ALLHAT-LLT, ASCOT-LLA and CARDS showed that for statin therapy to demonstrate a significant benefit, hypertensive or diabetic patients must be at sufficiently high risk of cardiovascular events. The emphasis is now on the risk level for developing cardiovascular events, and treatment should target the high-risk group and not the lipid level of the patient. No therapy is free of adverse effect. Treatment of those most at risk will bring the most benefit; treatment of those not at high risk of cardiovascular disease may expose patients who would not benefit much from therapy to its adverse effects. SN - 1460-2725 UR - https://www.unboundmedicine.com/medline/citation/16006501/The_statin_studies:_from_targeting_hypercholesterolaemia_to_targeting_the_high_risk_patient_ L2 - https://academic.oup.com/qjmed/article-lookup/doi/10.1093/qjmed/hci093 DB - PRIME DP - Unbound Medicine ER -