Abstract
Numerous randomized, double blind, placebo-controlled studies and observational studies have shown that statins reduce mortality and major cardiovascular events in high-risk patients with hypercholesterolemia. The Heart Protection Study showed that statins reduced mortality and major cardiovascular events in high-risk patients regardless of the initial level of serum lipids, age, or gender. The updated National Cholesterol Education program III guidelines state that in very high-risk persons, a serum low-density lipoprotein (LDL) cholesterol level of <70 mg/L is a reasonable clinical strategy. For moderately high-risk persons ( 2 or more risk factors and a 10-year risk for coronary artery disease of 10% to 20%), the serum LDL cholesterol should be reduced to <100 mg/dL. When LDL cholesterol-lowering drug therapy is used to treat high-risk persons or moderately high-risk persons, the serum LDL cholesterol should be reduced at least 30% to 40%. The serum LDL cholesterol should be decreased to less than 160 mg/dl in persons at low risk for cardiovascular disease. Addition of other lipid-lowering drugs to statin therapy has not been found to further reduce cardiovascular events and mortality.
Highlights
Numerous randomized, double blind, placebo-controlled studies and observational studies have shown that statins reduce mortality and major cardiovascular events in high-risk patients with hypercholesterolemia
Over the course of the study, dalcetrapib increased serum high-density lipoprotein (HDL) cholesterol by 31% to 40% and had a minimal effect on serum low-density lipoprotein (LDL) cholesterol levels
The National Cholesterol Education Program (NCEP) III guidelines recommended that the serum LDL cholesterol be lowered to less than 100 mg/dL in patients with coronary artery disease (CAD), other clinical forms of atherosclerotic vascular disease, diabetes, and with 2+ risk factors that confer a 10-year risk for CAD greater than 20%, regardless of age [26]
Summary
By 39%, stroke by 40%, and coronary revascularization by 32% [22]. For every 1,000 patients aged 65 to 75 years treated for 5 years with pravastatin, 225 cardiovascular hospitalizations would be prevented compared with prevention of 121 cardiovascular hospitalizations in 1,000 younger patients [22]. At 2-year follow-up, the primary end point of death from any cause, MI, documented unstable angina requiring rehospitalization, coronary revascularization (performed at least 30 days after randomization), and stroke was 26.3% in the pravastatin group versus 22.4% in the atorvastatin group, a significant 16% decrease in favor of atorvastatin [35]. Atorvastatin significantly lowered serum LDL cholesterol levels, insignificantly decreased major acute cardiovascular events by 22%, and significantly reduced all-cause mortality by 67% [38]. At 1.9-year median follow-up, rosuvastatin significantly decreased serum LDL cholesterol levels by 50%, high-sensitivity C-reactive protein levels by 37%, and the primary end point of MI, stroke, arterial revascularization, hospitalization for unstable angina, or death from cardiovascular causes by 44% [40]. At 3.9-year follow-up, compared to treatment with simvastatin or simvastatin/ ezetimibe, addition of niacin did not decrease the primary outcome of major vascular events but increased 31 serious adverse events per 1,000 niacin-treated patients
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