Cholesterol lowering in atherosclerosis.
Lipid-lowering with statins reduces disease progression, prevents myocardial infarction and other hard end points, and prolongs survival. Data from large-scale trials with these agents further show that lowering low-density lipoprotein (LDL) cholesterol in patients with coronary artery disease reduces the incidence of cardiovascular events and that the lower the LDL cholesterol achieved, the lower the event rate. Currently available evidence supports the National Cholesterol Education Program (NCEP) recommendations for reduction of LDL-cholesterol levels to at least 100 mg/dL in patients with coronary artery disease. The Treating to New Targets study, which will evaluate the effects of LDL-cholesterol lowering to < or = 75 mg/dL with atorvastatin, may help clarify if additional benefit accrues with further reductions. However, up to 82% of patients with proven coronary disease are not even at the current NCEP lipid goal. Up to 55% need a > 30-mg/dL reduction in LDL cholesterol to reach that goal. These data suggest that many patients are not receiving a statin or are receiving an inadequate dose. Aggressive lipid lowering, although a desirable goal, does not yet appear to be standard practice.
Brown
W V
WV
Atlanta VA Medical Center, Medical Service, Decatur, Georgia 30033, USA.
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069059:Atorvastatin; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy*; D018450:Disease Progression; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D017035:Pravastatin / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use*; D019821:Simvastatin / Q000627:therapeutic use
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin; D019821:Simvastatin; D017035:Pravastatin