Evidence-based guidelines for cardiovascular risk reduction: the safety and efficacy of high-dose statin therapy.
Current clinical guidelines for management of low-density lipoprotein cholesterol (LDL-C) have evolved to reflect the findings of numerous randomized clinical trials and represent an important opportunity to effectively improve the cardiovascular (CV) risk profile of a wide range of patients. Implementation of guideline-recommended LDL-C management strategies facilitates the appropriate use of all available treatments, including lifestyle and dietary changes and pharmacotherapy. Where intensive lowering of LDL-C is required, suboptimal use of statins is a major contributor to the significant number of patients who remain at an unnecessarily increased risk of CV disease as a consequence of failing to reach their guideline-recommended LDL-C goals. This underuse may be explained by concerns over the safety and efficacy of high-dose statin regimens in certain populations. These issues are explored in the context of current, evidence-based clinical guidelines for LDL-C management and, through 3 hypothetical case studies, selection of appropriate starting doses of statins, and titration to a higher dose or switching to a more potent statin, to ensure that patients reach their individual LDL-C goals and reduce their overall CV risk, is also examined.
The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. mashen1@jhmi.edu
Marie Dominique
MD
Ashen
Joanne M
JM
Foody
D002318:Cardiovascular Diseases / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood; D004334:Drug Administration Schedule; D064420:Drug-Related Side Effects and Adverse Reactions; D019317:Evidence-Based Medicine; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D024821:Metabolic Syndrome / Q000628:therapy; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control / Q000534:rehabilitation; D017410:Practice Guidelines as Topic; D012308:Risk Management
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors