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Evidence supporting primary prevention of cardiovascular diseases with statins: Gaps between updated clinical results and actual practice.
Arch Cardiovasc Dis 2014; 107(3):188-200AC

Abstract

The use of pharmacological lipid-lowering intervention in individuals with hypercholesterolaemia and known cardiovascular disease or diabetes/chronic kidney disease is well established. Current European Society of Cardiology guidelines recommend immediate initiation of drugs in adjunct to lifestyle intervention in these patients at high or very high cardiovascular risk. In these clinical settings, statins are generally chosen as the first-choice drug intervention, in consideration of the robust evidence showing a reduction in all-cause mortality and major adverse cardiac events (MACE). In contrast, primary prevention with statins, even in the subset of patients at high-risk of cardiovascular events, is not well implemented. This might be related to a lack of public awareness regarding the actual risk associated with prolonged exposure to high concentrations of low-density lipoprotein cholesterol (LDL-C) and uncertainties in the clinical evidence coming from the earliest trials in this patient subset. However, recent observational studies suggest that lowering LDL-C earlier in life and for a longer duration can substantially decrease the burden of cardiovascular disease and mortality. Moreover, results from recent well-conducted large meta-analyses of randomized clinical trials showed that primary prevention with statins reduced all-cause mortality by 14% and MACE by > 20% - findings similar to those observed for the use of statins in secondary prevention. Recently published American Heart Association/American College of Cardiology guidelines on the treatment of blood cholesterol emphasize that primary prevention using high-dose statins in individuals with LDL-C ≥ 190 mg/dL induces a benefit in atherosclerotic cardiovascular risk reduction that clearly exceeds the potential for adverse effects. We aim in this review to discuss the new data that advocate the use of statins in primary prevention earlier and more frequently, putting the efficacy evidence into perspective with new insights in terms of safety issues.

Authors+Show Affiliations

Department of Endocrinology and Metabolism, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.Department of Cardiology, Toulouse Rangueil University Hospital, 1, avenue du Professeur-Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France. Electronic address: jean.ferrieres@univ-tlse3.fr.

Pub Type(s)

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

Language

eng

PubMed ID

24613429

Citation

Bruckert, Eric, and Jean Ferrières. "Evidence Supporting Primary Prevention of Cardiovascular Diseases With Statins: Gaps Between Updated Clinical Results and Actual Practice." Archives of Cardiovascular Diseases, vol. 107, no. 3, 2014, pp. 188-200.
Bruckert E, Ferrières J. Evidence supporting primary prevention of cardiovascular diseases with statins: Gaps between updated clinical results and actual practice. Arch Cardiovasc Dis. 2014;107(3):188-200.
Bruckert, E., & Ferrières, J. (2014). Evidence supporting primary prevention of cardiovascular diseases with statins: Gaps between updated clinical results and actual practice. Archives of Cardiovascular Diseases, 107(3), pp. 188-200. doi:10.1016/j.acvd.2014.01.011.
Bruckert E, Ferrières J. Evidence Supporting Primary Prevention of Cardiovascular Diseases With Statins: Gaps Between Updated Clinical Results and Actual Practice. Arch Cardiovasc Dis. 2014;107(3):188-200. PubMed PMID: 24613429.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evidence supporting primary prevention of cardiovascular diseases with statins: Gaps between updated clinical results and actual practice. AU - Bruckert,Eric, AU - Ferrières,Jean, Y1 - 2014/03/07/ PY - 2013/11/28/received PY - 2014/01/27/revised PY - 2014/01/28/accepted PY - 2014/3/12/entrez PY - 2014/3/13/pubmed PY - 2014/12/15/medline KW - Cardiovascular diseases KW - HTA KW - High blood pressure KW - LDL-cholestérol KW - Low-density lipoprotein cholesterol KW - Maladies cardiovasculaires KW - Primary prevention KW - Prévention primaire KW - Statines KW - Statins SP - 188 EP - 200 JF - Archives of cardiovascular diseases JO - Arch Cardiovasc Dis VL - 107 IS - 3 N2 - The use of pharmacological lipid-lowering intervention in individuals with hypercholesterolaemia and known cardiovascular disease or diabetes/chronic kidney disease is well established. Current European Society of Cardiology guidelines recommend immediate initiation of drugs in adjunct to lifestyle intervention in these patients at high or very high cardiovascular risk. In these clinical settings, statins are generally chosen as the first-choice drug intervention, in consideration of the robust evidence showing a reduction in all-cause mortality and major adverse cardiac events (MACE). In contrast, primary prevention with statins, even in the subset of patients at high-risk of cardiovascular events, is not well implemented. This might be related to a lack of public awareness regarding the actual risk associated with prolonged exposure to high concentrations of low-density lipoprotein cholesterol (LDL-C) and uncertainties in the clinical evidence coming from the earliest trials in this patient subset. However, recent observational studies suggest that lowering LDL-C earlier in life and for a longer duration can substantially decrease the burden of cardiovascular disease and mortality. Moreover, results from recent well-conducted large meta-analyses of randomized clinical trials showed that primary prevention with statins reduced all-cause mortality by 14% and MACE by > 20% - findings similar to those observed for the use of statins in secondary prevention. Recently published American Heart Association/American College of Cardiology guidelines on the treatment of blood cholesterol emphasize that primary prevention using high-dose statins in individuals with LDL-C ≥ 190 mg/dL induces a benefit in atherosclerotic cardiovascular risk reduction that clearly exceeds the potential for adverse effects. We aim in this review to discuss the new data that advocate the use of statins in primary prevention earlier and more frequently, putting the efficacy evidence into perspective with new insights in terms of safety issues. SN - 1875-2128 UR - https://www.unboundmedicine.com/medline/citation/24613429/Evidence_supporting_primary_prevention_of_cardiovascular_diseases_with_statins:_Gaps_between_updated_clinical_results_and_actual_practice_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1875-2136(14)00027-8 DB - PRIME DP - Unbound Medicine ER -