Lipid modifying agents: mechanisms of action and reduction of cardiovascular disease.
1. Recent studies (4S, CARE, WOSCOPS) with the HMG CoA reductase inhibitors have shown that reductions of total cholesterol and LDL cholesterol reduce the risk for a new fatal or non-fatal cardiac event by approximately 30-35%, providing LDL is decreased by 25-35%. 2. Preliminary data also suggest that achieved LDL levels around 3.2 mmol/L results in no greater reduction in new events than when LDL is lowered even further. 3. There is considerable debate, nonetheless, as to whether these reduction in cardiovascular events are entirely a consequence of LDL reduction or whether the lipid-modifying agents have effects on lipoprotein structure, endothelial cell function, clotting and haemorrheological pathways. 4. The study results achieved with statins have obscured the role of fibrates as useful agents for reducing cardiovascular disease. Fibrates have a different mode of action to stains by reducing triglyceride-rich lipoprotein precursors and favourably altering LDL and HDL composition. 5. The practising clinician needs to consider the lipoprotein phenotype and to choose whether the ideal treatment is stain alone, fibrate alone or perhaps a combination.
Scott
R
R
Lipid and Diabetes Research Group, Christchurch Hospital, New Zealand.
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000097:blood / Q000517:prevention & control*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D004359:Drug Therapy, Combination; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
D000924:Anticholesteremic Agents; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents