Lower is better--the contemporary concept of low-density lipoprotein lowering in the preventive management of cardiovascular risk: does this apply to all patients?
The number of multiple outcomes-based clinical trials evaluating the use of statin drugs for lowering cardiovascular risk continues to grow, incorporating patients requiring primary and secondary preventive care. This review surveys the most recently published studies and identifies both the more extensive patient population that may benefit from primary preventive care and the concept of aggressive titration of the statin drug to improve the prognosis of the patient undergoing secondary preventive care. Data on the elderly patient, the female patient, and the diabetic patient are reviewed, as are the possible mechanisms of action of the statins in modifying cardiovascular risk. The pleiotropic effects and anti-inflammatory capabilities of the drugs are also reviewed. Conclusions are drawn regarding the contemporary use of statins in the primary and secondary preventive management of patients to significantly reduce cardiovascular risk.
Nixon
J V
JV
Division of Cardiology, Medical College of Virginia at Virginia Commonwealth University, Richmond, VA 23298-0051, USA jnixon@hsc.vcu.edu
D000367:Age Factors; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008077:Lipoproteins, LDL / Q000097:blood / Q000187:drug effects*; D011322:Primary Prevention; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012308:Risk Management; D012737:Sex Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008077:Lipoproteins, LDL