[Are the guidelines correct? Should all patients with coronary heart disease or diabetes be treated with a statin?].
On the basis of large randomized trials, current guidelines recommend to treat all patients with type 2 diabetes or coronary artery disease after myocardial infarction with statin drugs. However, the recent 4D, CORONA and GISSI-HF trials show that old patients with ischemic heart failure and patients with diabetes and end-stage renal disease on hemodialysis do not benefit from new onset of statin therapy with regard to mortality. The survival benefit from statin therapy appears to stem primarily from the prevention of progression of coronary artery disease. In clinical conditions where coronary artery disease does not significantly contribute to the cause of death, statins seem to be less effective. In patients at risk of organ damage, statin therapy therefore has to be initiated early in the course of the disease. The effect of statin withdrawal in ischemic heart failure or in patients with advanced renal disease is not known and potentially harmful and therefore, on the basis of the available evidence, ongoing statin treatment should not be stopped in these patients.
Pöss
Janine
J
Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. Janine.poess@gmx.de
Böhm
Michael
M
Laufs
Ulrich
U
D000368:Aged; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000401:mortality; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000401:mortality; D018450:Disease Progression; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D055502:Secondary Prevention; D015996:Survival Rate; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors