If cardiac patients benefit from statins, why not commonly prescribe them and follow up their use?

Abstract

In addition to cigarette smoking and hypertension, hyperlipidemia is perhaps the most firmly established risk factor for coronary artery disease (CAD). In most patients, hyperlipidemia is associated with a lifelong diet rich in saturated fats and low in fruits and vegetables [ [1] Krauss R AHA Dietary Guidelines. Revision 2000: A statement for health care professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000; 102: 2284-2299 Crossref PubMed Scopus (1403) Google Scholar ]. It is also associated with other adverse lifestyles, most often characterized by a lack of physical exercise and by chronic psychological distress. Thus, lowering elevated total and LDL-cholesterol, as well as triglycerides, preferably together with the other established risk factors, has become the most important target for risk factor modification and secondary prevention in susceptible CAD patients. In other words, it is best to “exercise regularly to help prevent having a first heart attack or a recurrence. If you smoke, stop completely. If you have high blood pressure, high cholesterol, or diabetes, work with your doctor to keep the condition under control; and maintain a healthy weight and eat a low-fat diet” [ [2] J Am Med Assoc Patient Page. Heart attack treatments. J. Am. Med. Assoc. 1999; 282: 402 Crossref Google Scholar ]. Increasing numbers of non-pharmacological, randomized, controlled, behavioral intervention studies aimed at healthy lifestyle changes in CAD patients have demonstrated that smoking cessation rates can be enhanced, hypertension and total and LDL-cholesterol levels reduced, and exercise rates, psychological distress, and quality of life ameliorated in these patients [ 3 Linden W Stossel C Maurice J Psychosocial interventions for patients with coronary artery disease. A meta-analysis. Arch. Intern. Med. 1996; 156: 745-752 Crossref PubMed Google Scholar , 4 Dusseldorp E van Elderen T Maes S Meulman J Kraaij V A meta-analysis of psychoeducational programs for coronary heart disease patients. Health Psychol. 1999; 18: 506-519 Crossref PubMed Scopus (422) Google Scholar , 5 Sebregts E Falger P Bär F Risk factor modification through non-pharmacological interventions in patients with coronary heart disease. J. Psychosom. Res. 2000; 48: 425-441 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar ]. Moreover, clinically significant and lasting reductions in the extent of coronary atherosclerosis in CAD-patients have been reported after intensive stress management and exercise interventions and lifestyle changes [ 6 Haskell W Alderman E Fair J et al. The Stanford Coronary Risk Intervention Project (SCRIP)Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. Circulation. 1994; 89: 975-990 Crossref PubMed Scopus (764) Google Scholar , 7 Niebauer J Hambrecht R Velich T et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention. Role of physical exercise. Circulation. 1997; 96: 2534-2541 Crossref PubMed Scopus (309) Google Scholar , 8 Ornish D Scherwitz L Billings J et al. Intensive lifestyle changes for reversal of coronary heart disease. J. Am. Med. Assoc. 1998; 280: 2001-2007 Crossref PubMed Scopus (1125) Google Scholar ]. Finally, prevention of psychological distress, heart-healthy lifestyles, and moderate exercise may not only contribute to a reduction in atherosclerosis, but they may also be instrumental in diminishing inflammatory risk in unstable, atherosclerotic coronary plaques [ [9] Libby P Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 2001; 104: 365-372 Crossref PubMed Scopus (1329) Google Scholar ]. Thus, in principle, an optimal, individualized combination of these programs should be offered to eligible CAD patients shortly after their recent coronary events in order to reduce cardiac recurrence and enhance quality of life.