[Postinfarction statins. An unquestionable benefit. A therapeutic strategy that can be improved].
Atherosclerotic disease is etiopathogenically related to the presence of hypercholesterolemia. Physicians have never had until now a generation of lipid-lowering drugs with a comparable degree of efficacy, potency and safety as statins. The most explored field with statins has been the post myocardial infarction period, since this type of patients is at high risk of new cardiovascular events and, as a consequence, can obtain a marked benefit from intervention. Accordingly, three large-scale clinical trials with statins have conclusively demonstrated a significant reduction in cardiovascular events and in mortality after myocardial infarction. Nevertheless, although there is convincing evidence that statins should be implemented after myocardial infarction, there are still a number of relevant questions open and under study. The first of them is the value of the so-called pleiotropic properties of statins (additional properties independent from cholesterol lowering), so important for plaque stabilization. In addition, there is uncertainty about how early treatment with statins has to be started after the acute phase. Another point we do not know is the goal of lipid intervention (the level of total or LDL-cholesterol to be achieved). In fact, there is still a debate on whether patients with average levels of cholesterol or even with low levels are to treated. Finally, but related to the previous question, it would be very interesting to determine whether high doses of statins, are necessary or can low doses be equally efficacious. In conclusion, statins are a landmark in cholesterol-lowering interventions after myocardial infarction. Probably, the majority of survivors should be treated. At present, active research is focused on delineating more precisely the manner in which these drugs are to be used to prolong life in these patients.
Galve
Enrique
E
Servei de Cardiologia, Hospital General Vall d'Hebron, Pg Vall d'Hebron 119-129, 08035, Barcelona, España. egalveb@meditex.es
D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D002986:Clinical Trials as Topic; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications*
D000960:Hypolipidemic Agents; D002784:Cholesterol
Estatinas postinfarto. Un beneficio incuestionable. Una estrategia terapéutica perfeccionable.