[Secondary prevention of coronary artery disease with lipid-lowering drugs].
Before the statins era, this was one of the most debated questions in the field of cardiology: although hypolipidemic drugs (mainly fibrates) decreased the cardiovascular morbidity and mortality, their influence on total mortality was not significant. The 4S study demonstrated the efficacy of a statin on cardiovascular morbidity and mortality and on total mortality. This was confirmed by the CARE and the LIPID trials. Statins should be prescribed to all coronary patients, whatever the type of coronary disease, the age (we do not know yet for people older than 80), the gender, the basal cholesterol level (maybe statins are not efficacious when it is<2g/l); cholesterol level has to be lowered below 2g/l. Two trials of drugs increasing the HDL cholesterol level were recently published. Unfortunately their results are contradictory. Statins should be the first level drugs. Maybe it is useful to decrease the triglycerides level and to increase the HDL cholesterol level. The association of a statin and a fibrate is reserved to specialized centers. We should not forget the usefulness of diet. We must also take the other risk factors into account.
Delahaye
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Service de Cardiologie, Hôpital Cardiovasculaire et Pneumologique Louis-Pradel, BP Lyon Montchat, 69394 Lyon Cedex 3. francois.delahaye@chu-lyon.fr
De Gevigney
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D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D018579:Patient Selection; D017035:Pravastatin / Q000627:therapeutic use; D012307:Risk Factors; D019821:Simvastatin / Q000627:therapeutic use; D016896:Treatment Outcome
D008076:Cholesterol, HDL; D000960:Hypolipidemic Agents; D002784:Cholesterol; D019821:Simvastatin; D017035:Pravastatin