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Cardiovascular risk reduction: what do recent trials with rosuvastatin tell us?

Abstract

Abundant evidence from large-scale clinical trials supports the importance of lowering low-density lipoprotein cholesterol (LDL-C) to decrease the risk of cardiovascular disease (CVD) events. The LDL-C targets in various guidelines remain important treatment goals but, even in trials where statin therapy achieves substantial reduction of LDL-C, a significant number of CVD events still occur and the residual risk remains high. These findings suggest that lipid parameters other than LDL-C, such as high-density lipoprotein cholesterol (HDL-C), triglycerides, and LDL particle size, can influence the risk of CVD. On this basis, other strategies that can alter the lipid profile, in particular raising HDL.C, may provide additional benefits. Other factors such as HDL-C functionality and susceptibility to oxidation and inflammatory factors can also influence cardiovascular risk. In addition to the modifications of the lipid profile, statins have cholesterol-independent beneficial pleiotropic effects. The contribution of these effects to event reduction is not yet fully understood. Recently, the body of evidence has expanded to support the use of intensive statin therapy in broader patient populations. The JUPITER trial has shown the benefit of intensive statin treatment in low-risk subjects with high levels of high-sensitivity C-reactive protein and average levels of LDL-C. Unlike the setting of primary and secondary prevention, the results of statin trials in patients with heart failure have shown no clear benefit in terms of survival. The recently published AURORA trial was carried out to investigate the effect of rosuvastatin in patients with end-stage renal disease undergoing chronic hemodialysis. In this trial no benefit on cardiovascular events was shown with statin therapy. In conclusion, large outcomes trials have clearly shown that statin treatments have a favorable benefit/risk profile in a large range of patients at different levels of risk, with the exception of patients with heart failure and those with renal disease undergoing dialysis. Further evidence is needed on the role of therapeutic strategies on the so-called residual risk.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    ANMCO Research Center, Via La Marmora 34, 50121 Florence, Italy.

    Source

    Advances in therapy 26:5 2009 May pg 469-87

    MeSH

    Cardiovascular Diseases
    Cholesterol, HDL
    Cholesterol, LDL
    Clinical Trials as Topic
    Disease Progression
    Evidence-Based Medicine
    Fluorobenzenes
    Heart Failure
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Hypercholesterolemia
    Inflammation
    Kidney Failure, Chronic
    Practice Guidelines as Topic
    Primary Prevention
    Pyrimidines
    Risk Factors
    Risk Reduction Behavior
    Rosuvastatin Calcium
    Sulfonamides
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    19444394

    Citation

    Fabbri, Gianna, and Aldo Pietro Maggioni. "Cardiovascular Risk Reduction: what Do Recent Trials With Rosuvastatin Tell Us?" Advances in Therapy, vol. 26, no. 5, 2009, pp. 469-87.
    Fabbri G, Maggioni AP. Cardiovascular risk reduction: what do recent trials with rosuvastatin tell us? Adv Ther. 2009;26(5):469-87.
    Fabbri, G., & Maggioni, A. P. (2009). Cardiovascular risk reduction: what do recent trials with rosuvastatin tell us? Advances in Therapy, 26(5), pp. 469-87. doi:10.1007/s12325-009-0025-6.
    Fabbri G, Maggioni AP. Cardiovascular Risk Reduction: what Do Recent Trials With Rosuvastatin Tell Us. Adv Ther. 2009;26(5):469-87. PubMed PMID: 19444394.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cardiovascular risk reduction: what do recent trials with rosuvastatin tell us? AU - Fabbri,Gianna, AU - Maggioni,Aldo Pietro, Y1 - 2009/05/14/ PY - 2009/04/08/received PY - 2009/5/16/entrez PY - 2009/5/16/pubmed PY - 2010/3/6/medline SP - 469 EP - 87 JF - Advances in therapy JO - Adv Ther VL - 26 IS - 5 N2 - Abundant evidence from large-scale clinical trials supports the importance of lowering low-density lipoprotein cholesterol (LDL-C) to decrease the risk of cardiovascular disease (CVD) events. The LDL-C targets in various guidelines remain important treatment goals but, even in trials where statin therapy achieves substantial reduction of LDL-C, a significant number of CVD events still occur and the residual risk remains high. These findings suggest that lipid parameters other than LDL-C, such as high-density lipoprotein cholesterol (HDL-C), triglycerides, and LDL particle size, can influence the risk of CVD. On this basis, other strategies that can alter the lipid profile, in particular raising HDL.C, may provide additional benefits. Other factors such as HDL-C functionality and susceptibility to oxidation and inflammatory factors can also influence cardiovascular risk. In addition to the modifications of the lipid profile, statins have cholesterol-independent beneficial pleiotropic effects. The contribution of these effects to event reduction is not yet fully understood. Recently, the body of evidence has expanded to support the use of intensive statin therapy in broader patient populations. The JUPITER trial has shown the benefit of intensive statin treatment in low-risk subjects with high levels of high-sensitivity C-reactive protein and average levels of LDL-C. Unlike the setting of primary and secondary prevention, the results of statin trials in patients with heart failure have shown no clear benefit in terms of survival. The recently published AURORA trial was carried out to investigate the effect of rosuvastatin in patients with end-stage renal disease undergoing chronic hemodialysis. In this trial no benefit on cardiovascular events was shown with statin therapy. In conclusion, large outcomes trials have clearly shown that statin treatments have a favorable benefit/risk profile in a large range of patients at different levels of risk, with the exception of patients with heart failure and those with renal disease undergoing dialysis. Further evidence is needed on the role of therapeutic strategies on the so-called residual risk. SN - 1865-8652 UR - https://www.unboundmedicine.com/medline/citation/19444394/Cardiovascular_risk_reduction:_what_do_recent_trials_with_rosuvastatin_tell_us L2 - https://dx.doi.org/10.1007/s12325-009-0025-6 DB - PRIME DP - Unbound Medicine ER -