[Statins: for the time being, do not as a rule prescribe the maximum dose].
Several large clinical trials have demonstrated the ability of statins to lower the risk of cardiovascular disease and mortality. An unresolved issue, however, has been the appropriate dose of statin therapy. High-dose statins lower LDL-cholesterol more efficiently, but it remains questionable whether they reduce morbidity and mortality more than lower doses. Recently, two large clinical trials have been published that address these issues. The 'Treat to new targets' trial appears most relevant for clinical practice. In this trial, high-dose atorvastatin (80 mg per day) was more effective in reducing cardiovascular events than low-dose atorvastatin (10 mg per day) in patients whose LDL-cholesterol level was previously lowered to 3.4 mmol/l or less with the 10-mg dose. However, overall mortality did not differ due to increased mortality from noncardiac causes in the high-dose group. These findings raise important questions regarding safety and the indications for high-dose statins. Further studies are needed to resolve these issues. In the mean time, it seems reasonable to reserve high-dose statin therapy for patients who are at a very high cardiovascular risk, for example those with a history of recurrent cardiovascular events.
Smulders
Y M
YM
VU Medisch Centrum, afd. Algemene Inwendige Geneeskunde, De Boelelaan 1117, 1081 HV Amsterdam. y.smulders@vumc.nl
D000924:Anticholesteremic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D006538:Heptanoic Acids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D011758:Pyrroles / Q000008:administration & dosage* / Q000009:adverse effects
D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D011758:Pyrroles; D000069059:Atorvastatin