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The safety and efficacy of achieving very low LDL-cholesterol concentrations with high dose statin therapy.
Curr Opin Lipidol 2006; 17(6):626-30CO

Abstract

PURPOSE OF REVIEW

The benefits of lipid lowering with statins are established in patients with or at risk for coronary artery disease. Recent trials with high doses of potent statins have examined treating to very low levels of LDL-cholesterol. Concerns have been raised about the safety of this strategy. This review examines the safety and efficacy of treating to very low LDL-cholesterol.

RECENT FINDINGS

Four clinical trials, Treating to New Targets (TNT) and Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) in stable coronary artery disease and Aggrastat to Zocor (A to Z) and Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT)-TIMI 22 following acute coronary syndromes, have examined intensive statin therapy compared to moderate statin therapy. These trials and a meta-analysis demonstrated that intensive statin therapy reduces cardiovascular events. Subsequent analyses from these trials suggest that very low levels of LDL-cholesterol can be achieved safely and may improve clinical outcomes. A note of caution regarding hemorrhagic events following stroke with intensive statin therapy was raised by the Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL) trial despite impressive reductions in cardiovascular events.

SUMMARY

A growing body of evidence suggests progressive benefit for lowering LDL-cholesterol aggressively with intensive statin therapy in coronary artery disease. Future trials will be needed to define whether there is a level of LDL-cholesterol beyond which further benefit is not seen or safety concerns emerge.

Authors+Show Affiliations

Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. swiviott@partners.orgNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

17095906

Citation

Wiviott, Stephen D., and Christopher P. Cannon. "The Safety and Efficacy of Achieving Very Low LDL-cholesterol Concentrations With High Dose Statin Therapy." Current Opinion in Lipidology, vol. 17, no. 6, 2006, pp. 626-30.
Wiviott SD, Cannon CP. The safety and efficacy of achieving very low LDL-cholesterol concentrations with high dose statin therapy. Curr Opin Lipidol. 2006;17(6):626-30.
Wiviott, S. D., & Cannon, C. P. (2006). The safety and efficacy of achieving very low LDL-cholesterol concentrations with high dose statin therapy. Current Opinion in Lipidology, 17(6), pp. 626-30.
Wiviott SD, Cannon CP. The Safety and Efficacy of Achieving Very Low LDL-cholesterol Concentrations With High Dose Statin Therapy. Curr Opin Lipidol. 2006;17(6):626-30. PubMed PMID: 17095906.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The safety and efficacy of achieving very low LDL-cholesterol concentrations with high dose statin therapy. AU - Wiviott,Stephen D, AU - Cannon,Christopher P, PY - 2006/11/11/pubmed PY - 2007/3/14/medline PY - 2006/11/11/entrez SP - 626 EP - 30 JF - Current opinion in lipidology JO - Curr. Opin. Lipidol. VL - 17 IS - 6 N2 - PURPOSE OF REVIEW: The benefits of lipid lowering with statins are established in patients with or at risk for coronary artery disease. Recent trials with high doses of potent statins have examined treating to very low levels of LDL-cholesterol. Concerns have been raised about the safety of this strategy. This review examines the safety and efficacy of treating to very low LDL-cholesterol. RECENT FINDINGS: Four clinical trials, Treating to New Targets (TNT) and Incremental Decrease in End Points Through Aggressive Lipid Lowering (IDEAL) in stable coronary artery disease and Aggrastat to Zocor (A to Z) and Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT)-TIMI 22 following acute coronary syndromes, have examined intensive statin therapy compared to moderate statin therapy. These trials and a meta-analysis demonstrated that intensive statin therapy reduces cardiovascular events. Subsequent analyses from these trials suggest that very low levels of LDL-cholesterol can be achieved safely and may improve clinical outcomes. A note of caution regarding hemorrhagic events following stroke with intensive statin therapy was raised by the Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL) trial despite impressive reductions in cardiovascular events. SUMMARY: A growing body of evidence suggests progressive benefit for lowering LDL-cholesterol aggressively with intensive statin therapy in coronary artery disease. Future trials will be needed to define whether there is a level of LDL-cholesterol beyond which further benefit is not seen or safety concerns emerge. SN - 0957-9672 UR - https://www.unboundmedicine.com/medline/citation/17095906/The_safety_and_efficacy_of_achieving_very_low_LDL_cholesterol_concentrations_with_high_dose_statin_therapy_ L2 - http://dx.doi.org/10.1097/MOL.0b013e328010872d DB - PRIME DP - Unbound Medicine ER -