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Statin therapy for prevention and treatment of acute and chronic cardiovascular disease: update on recent trials and metaanalyses.

Abstract

PURPOSE OF REVIEW

To summarize the evidence from recent clinical trials and metaanalyses on the efficacy of statin therapy to reduce death, myocardial infarction and stroke, and to review the effects of statins in patients with low LDL cholesterol, diabetes, end-stage renal disease, and acute coronary syndrome.

RECENT FINDINGS

In large metaanalyses of randomized controlled trials relative risk reductions from statins compared with placebo for patients with manifest or with risk factors for coronary artery disease were 13% for overall mortality, 26% for fatal and nonfatal myocardial infarction, and 18% for fatal and nonfatal stroke. Evidence from large trials suggests that patients with type II diabetes compared with patients without diabetes have similar risk reductions from statins for cardiovascular events, but this benefit is not seen in patients with diabetes and end-stage renal disease. In patients with acute coronary syndrome, early treatment with high-dose atorvastatin reduces cardiovascular morbidity after the first 4 months following the event, but the impact on mortality endpoints remains less clear. Results from recent trials in patients with stable coronary artery disease or type II diabetes suggest that statins provide benefit at considerable low LDL cholesterol levels. Therefore, target values for LDL cholesterol of less than 1.8 mmol/l (<70 mg/dl) should be considered for all patients with coronary artery disease or equivalent coronary risk.

SUMMARY

For patients at high risk of coronary artery disease there is growing evidence for the concept of 'the lower, the better' regarding LDL cholesterol levels. Ongoing trials are further investigating the safety of lower target values in patients at various risk of coronary artery disease.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Basel Institute for Clinical Epidemiology, University Hospital Basel, Basel, Switzerland.

    ,

    Source

    Current opinion in lipidology 16:6 2005 Dec pg 601-5

    MeSH

    Acute Disease
    Cardiovascular Diseases
    Chronic Disease
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Meta-Analysis as Topic
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    16276235

    Citation

    Briel, Matthias, et al. "Statin Therapy for Prevention and Treatment of Acute and Chronic Cardiovascular Disease: Update On Recent Trials and Metaanalyses." Current Opinion in Lipidology, vol. 16, no. 6, 2005, pp. 601-5.
    Briel M, Nordmann AJ, Bucher HC. Statin therapy for prevention and treatment of acute and chronic cardiovascular disease: update on recent trials and metaanalyses. Curr Opin Lipidol. 2005;16(6):601-5.
    Briel, M., Nordmann, A. J., & Bucher, H. C. (2005). Statin therapy for prevention and treatment of acute and chronic cardiovascular disease: update on recent trials and metaanalyses. Current Opinion in Lipidology, 16(6), pp. 601-5.
    Briel M, Nordmann AJ, Bucher HC. Statin Therapy for Prevention and Treatment of Acute and Chronic Cardiovascular Disease: Update On Recent Trials and Metaanalyses. Curr Opin Lipidol. 2005;16(6):601-5. PubMed PMID: 16276235.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Statin therapy for prevention and treatment of acute and chronic cardiovascular disease: update on recent trials and metaanalyses. AU - Briel,Matthias, AU - Nordmann,Alain J, AU - Bucher,Heiner C, PY - 2005/11/9/pubmed PY - 2008/8/22/medline PY - 2005/11/9/entrez SP - 601 EP - 5 JF - Current opinion in lipidology JO - Curr. Opin. Lipidol. VL - 16 IS - 6 N2 - PURPOSE OF REVIEW: To summarize the evidence from recent clinical trials and metaanalyses on the efficacy of statin therapy to reduce death, myocardial infarction and stroke, and to review the effects of statins in patients with low LDL cholesterol, diabetes, end-stage renal disease, and acute coronary syndrome. RECENT FINDINGS: In large metaanalyses of randomized controlled trials relative risk reductions from statins compared with placebo for patients with manifest or with risk factors for coronary artery disease were 13% for overall mortality, 26% for fatal and nonfatal myocardial infarction, and 18% for fatal and nonfatal stroke. Evidence from large trials suggests that patients with type II diabetes compared with patients without diabetes have similar risk reductions from statins for cardiovascular events, but this benefit is not seen in patients with diabetes and end-stage renal disease. In patients with acute coronary syndrome, early treatment with high-dose atorvastatin reduces cardiovascular morbidity after the first 4 months following the event, but the impact on mortality endpoints remains less clear. Results from recent trials in patients with stable coronary artery disease or type II diabetes suggest that statins provide benefit at considerable low LDL cholesterol levels. Therefore, target values for LDL cholesterol of less than 1.8 mmol/l (<70 mg/dl) should be considered for all patients with coronary artery disease or equivalent coronary risk. SUMMARY: For patients at high risk of coronary artery disease there is growing evidence for the concept of 'the lower, the better' regarding LDL cholesterol levels. Ongoing trials are further investigating the safety of lower target values in patients at various risk of coronary artery disease. SN - 0957-9672 UR - https://www.unboundmedicine.com/medline/citation/16276235/Statin_therapy_for_prevention_and_treatment_of_acute_and_chronic_cardiovascular_disease:_update_on_recent_trials_and_metaanalyses_ L2 - http://Insights.ovid.com/pubmed?pmid=16276235 DB - PRIME DP - Unbound Medicine ER -