Limitations of statin monotherapy for the treatment of dyslipidemia: a projection based on the Canadian lipid study – observational (original) (raw)
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Statins and LDL-C in Secondary Prevention—So Much Progress, So Far to Go
JAMA Network Open
Elevated circulating concentrations of low-density lipoproteins have been definitively demonstrated to be a cause of atherosclerotic cardiovascular disease (ASCVD). Increasing recognition is given to the importance of reducing lifetime exposure to low-density lipoprotein cholesterol (LDL-C) 1 according to the rule of "the lower the better," but also "the earlier the better" and "the longer the better." Statin therapy reduces the risk of cardiovascular events by approximately a quarter for each reduction in low-density lipoprotein level of 38.6 mg/dL (1 mmol), and long-term LDL-C reduction + Related article Author affiliations and article information are listed at the end of this article.
Background-Statins reduce the risk of coronary heart disease (CHD) in individuals with a history of CHD or risk equivalents. A 10-year CHD risk >20% is considered a risk equivalent but is frequently not detected. Statin use and low density lipoprotein cholesterol (LDL-C) control were examined among participants with CHD or risk equivalents in the nationwide Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=8,812).
Therapeutics and Clinical Risk Management, 2015
Background: Elevated low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk of coronary artery disease. Current guidelines recommend an LDL-C target of 70 mg/dL (1.8 mmol/L) for acute coronary syndrome (ACS) patients, and the first-line treatment to lower lipids is statin therapy. Despite current guidelines and the efficacious lipid-lowering agents available, about half of patients at very high risk, including ACS patients, fail to achieve their LDL-C goal. This study assessed LDL-C goal attainment according to use of high and low potency statins in routine practice in Thailand. Methods: A retrospective cohort study was performed by retrieving data from medical records and the electronic hospital database for a tertiary care hospital in Thailand between 2009 and 2011. Included were ACS patients treated with statins at baseline and with follow-up of LDL-C levels. Patients were divided into high or low potency statin users, and the proportion reaching the LDL-C goal of 70 mg/dL was determined. A Cox proportional hazard model was applied to determine the relationship between statin potency and LDL-C goal attainment. Propensity score adjustment was used to control for confounding by indication. Results: Of 396 ACS patients (60% males, mean age 64.3±11.6 years), 229 (58%) were treated with high potency statins and 167 (42%) with low potency statins. A quarter reached their target LDL-C goal (25% for patients on high potency statins and 23% on low potency statins). High potency statins were not associated with increased LDL-C goal attainment (adjusted hazards ratio 1.22, 95% confidence interval 0.79-1.88; P=0.363). Conclusion: There was no significant effect of high potency statins on LDL-C goal attainment. Moreover, this study showed low LDL-C goal attainment for patients on either low or high potency statins. The reasons for the low LDL-C goal attainment rate warrants further investigation.
Current opinion in lipidology, 2014
Guidelines seeking to deploy statin treatment rely heavily on the use of estimates of absolute cardiovascular disease (CVD) risk as an arbiter of who should receive statins. We question whether this is an effective strategy unless the LDL-cholesterol (LDL-C) response is also considered. Recently, meta-analyses of randomized clinical trials of statins have revealed that CVD risk decreases linearly by 22% for each 1 mmol/l reduction in LDL-C. Calculation of the number needed to treat with statins to prevent one CVD event using both the pretreatment absolute CVD risk and the LDL-C response that can be achieved is thus possible. Application of this evidence reveals that many people (including younger ones) with high LDL-C levels can benefit more than people currently receiving statin treatment solely on the basis of their absolute CVD risk, whereas others at higher CVD risk, but with lower LDL-C, will derive little benefit. This does not seem to have been adequately considered in recent...
Circulation Journal, 2010
Once many epidemiological studies had proven an increase in coronary deaths and cardiac events associated with elevated levels of low-density lipoprotein-cholesterol (LDL-C), 1,2 the next clinical question became whether lowering LDL-C by drugs or diet would result in a reduction in cardiac events. This assessment was facilitated by the development of potent cholesterol-lowering drugs such as the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins). In particular, statin therapy was proposed as a strategy to improve clinical outcomes and accordingly, large clinical trials using statin were started. By 2000, there had been many reports of the results of such large-scale clinical trials 3-8 and there was abundant evidence of the significant beneficial effects of lipid-lowering treatment using statin in reducing mortality and cardiovascular morbidity in patients with CAD as shown in Table 1. Interestingly, all the long-term clinical trials demonstrated that the beneficial effects of statin treatment were sustained and cumulative compared with placebo group as shown in Table 1. In the meta-analysis performed by The opinions expressed in this article are not necessarily those of the editors or of the Japanese Circulation Society.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Patients with ischemic heart disease (IHD), including those with an acute coronary syndrome (ACS), should receive long-term, intensive lipid-lowering statin therapy. Target levels of low-density lipoprotein cholesterol (LDL-C) in patients with ACS are <70 mg/dl. Various studies have demonstrated that many high-risk patients do not achieve optimal LDL-C control in spite of being on adequate dose of lipid-lowering statin therapy. The aim of the present study was to analyse the control of LDL-C and high-density lipoprotein (HDL-C) levels after 12 weeks of statin therapy at different doses, in patients who had ACS and who underwent revascularization with or without a prior episode of ACS.
Reducing morbidity and mortality in high risk patients with statins
Vascular Health and Risk Management, 2009
Residual coronary heart disease remains a significant problem even after adequate statin therapy for cardiovascular risk reduction as currently recommended by the Adult Treatment Panel III (ATP-III) of the National Cholesterol Education Program (NCEP). This is particularly true for the high risk patients as defined by ATP-III that includes those patients who have a greater than 20% 10-year risk of adverse cardiac events. For such patients the current goal of a low-density lipoprotein cholesterol (LDL-cholesterol) maintenance level of 100 mg/dL plasma appears to be suboptimal. Accumulating data from several recent randomized studies of more aggressive LDL-cholesterol reduction to levels below 70 mg/dL in the high risk patients favor acceptance of such a new lower target for LDL-cholesterol using more intensive statin therapy which would affect the treatment strategy for patients with coronary heart disease prepercutaneous intervention, metabolic syndrome, diabetes mellitus, congestive heart failure, cerebro-vascular disease and chronic kidney disease.
BJGP Open, 2020
BackgroundClinical guidelines recommend specific targets for low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) for primary prevention of cardiovascular disease (CVD). Furthermore, individual variability in lipid response to statin therapy requires assessment of the association in diverse populations.AimTo assess whether lower concentrations of LDL-C and non-HDL-C are associated with a reduced risk of major adverse cardiovascular events (MACE) in primary prevention of CVD.Design & settingAn international, new-user, cohort study will be undertaken. It will use data from three electronic health record databases from three global regions: Clinical Practice Research Datalink, UK; PREDICT-CVD, New Zealand (NZ); and the Clinical Data and Analysis Reporting System, Hong Kong (HK).MethodNew statin users without a history of atherosclerotic CVD, heart failure, or chronic kidney disease, with baseline and follow-up lipid levels will be eligibl...