Clinical context: current concepts of coronary heart disease management.
Coronary heart disease (CHD) is the single greatest cause of death among adults in the United States. It is also a major cause of disability and is associated with direct and indirect costs that exceed $118 billion annually. Elevation of serum lipid levels, particularly low-density lipoprotein cholesterol (LDL-C) levels, is closely linked to the development of CHD. Lipid levels that increase the risk of CHD are present in nearly one third of the US population. Large-scale intervention studies have shown that decreasing LDL-C can significantly reduce the risk of cardiovascular mortality, adverse cardiovascular events, and the requirement for revascularization procedures. Statins are now thought the most effective agents for lowering LDL-C, and they also have positive effects on other components of the serum lipid profile. These drugs are also better tolerated than other lipid-lowering agents. Statin therapy significantly decreases the risk of cardiovascular disease and is a cost-effective cardiovascular treatment according to current standards. Because statins vary substantially in acquisition cost, using statins in the most cost-effective manner is important for controlling health-care costs. Optimizing the cost-effectiveness of statin therapy is a particular concern to managed care organizations in light of the large number of patients who are now considered candidates for this treatment.
Jacobson
T A
TA
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
D000924:Anticholesteremic Agents / Q000191:economics / Q000627:therapeutic use*; D002423:Cause of Death; D008078:Cholesterol, LDL / Q000097:blood* / Q000187:drug effects; D003327:Coronary Disease / Q000191:economics / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D018450:Disease Progression; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D008329:Managed Care Programs; D009017:Morbidity; D010349:Patient Compliance; D015995:Prevalence; D011322:Primary Prevention; D012307:Risk Factors; D012449:Safety
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL