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Statins and LDL-cholesterol lowering: an overview.
Curr Med Res Opin. 2005; 21 Suppl 6:S9-16.CM

Abstract

Statins have become a cornerstone of treatment for dyslipidaemia primarily due to their marked lowering of low-density lipoprotein cholesterol (LDL-C). Studies show that statin treatment typically reduces relative risk of cardiovascular disease by 24-37%, regardless of age, sex, prior history of coronary heart disease (CHD), or other co-morbid conditions. There is also a growing body of evidence that statins can be effective in people whose LDL-C is not considered elevated under current guidelines. In both the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) and the Collaborative Atorvastatin Diabetes Study (CARDS), participants randomised to atorvastatin (10 mg/day) experienced at least a one-third reduction in major cardiovascular events, even though at baseline, their LDL-C was within the normal range. Other studies have also provided evidence that more intensive lipid-lowering regimens could provide additional clinical benefits. In the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) trial, the first active-control clinical trial of CHD progression, an intensive lipid-lowering regimen using atorvastatin (80 mg/day) decreased atherogenic lipoproteins and atheroma volume in patients with established CHD, compared with a moderate regimen using pravastatin (40 mg/day). Furthermore, relative to baseline, there was no measurable atheroma progression in the atorvastatin group. While statin therapy does offer significant clinical benefit, 60-70% of major cardiovascular events are still not prevented, which underscores the need for alternative interventions. Targeting inflammatory mediators of atherosclerosis such as C-reactive protein (CRP), as well as combination therapy to simultaneously raise high-density lipoprotein cholesterol (HDL-C) and lower LDL-C, are among the promising new strategies for primary and secondary prevention of atherosclerotic disease. This article will summarise data concerning use of statins in patients without markedly elevated LDL-C. The issue of the ideal LDL-C target will also be considered before addressing future treatment options for dyslipidaemia.

Authors+Show Affiliations

Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. E.S.Stroes@amc.uva.nl

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16138936

Citation

Stroes, Erik. "Statins and LDL-cholesterol Lowering: an Overview." Current Medical Research and Opinion, vol. 21 Suppl 6, 2005, pp. S9-16.
Stroes E. Statins and LDL-cholesterol lowering: an overview. Curr Med Res Opin. 2005;21 Suppl 6:S9-16.
Stroes, E. (2005). Statins and LDL-cholesterol lowering: an overview. Current Medical Research and Opinion, 21 Suppl 6, S9-16.
Stroes E. Statins and LDL-cholesterol Lowering: an Overview. Curr Med Res Opin. 2005;21 Suppl 6:S9-16. PubMed PMID: 16138936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Statins and LDL-cholesterol lowering: an overview. A1 - Stroes,Erik, PY - 2005/9/6/pubmed PY - 2005/12/13/medline PY - 2005/9/6/entrez SP - S9 EP - 16 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 21 Suppl 6 N2 - Statins have become a cornerstone of treatment for dyslipidaemia primarily due to their marked lowering of low-density lipoprotein cholesterol (LDL-C). Studies show that statin treatment typically reduces relative risk of cardiovascular disease by 24-37%, regardless of age, sex, prior history of coronary heart disease (CHD), or other co-morbid conditions. There is also a growing body of evidence that statins can be effective in people whose LDL-C is not considered elevated under current guidelines. In both the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) and the Collaborative Atorvastatin Diabetes Study (CARDS), participants randomised to atorvastatin (10 mg/day) experienced at least a one-third reduction in major cardiovascular events, even though at baseline, their LDL-C was within the normal range. Other studies have also provided evidence that more intensive lipid-lowering regimens could provide additional clinical benefits. In the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) trial, the first active-control clinical trial of CHD progression, an intensive lipid-lowering regimen using atorvastatin (80 mg/day) decreased atherogenic lipoproteins and atheroma volume in patients with established CHD, compared with a moderate regimen using pravastatin (40 mg/day). Furthermore, relative to baseline, there was no measurable atheroma progression in the atorvastatin group. While statin therapy does offer significant clinical benefit, 60-70% of major cardiovascular events are still not prevented, which underscores the need for alternative interventions. Targeting inflammatory mediators of atherosclerosis such as C-reactive protein (CRP), as well as combination therapy to simultaneously raise high-density lipoprotein cholesterol (HDL-C) and lower LDL-C, are among the promising new strategies for primary and secondary prevention of atherosclerotic disease. This article will summarise data concerning use of statins in patients without markedly elevated LDL-C. The issue of the ideal LDL-C target will also be considered before addressing future treatment options for dyslipidaemia. SN - 0300-7995 UR - https://www.unboundmedicine.com/medline/citation/16138936/Statins_and_LDL_cholesterol_lowering:_an_overview_ L2 - http://www.tandfonline.com/doi/full/10.1185/030079905X59102 DB - PRIME DP - Unbound Medicine ER -