[From lipid target values to the JUPITER study. Significance of achieving lipid levels specified by the guidelines and deficiencies in practice].
In Hungary the life expectancy have increased by 4.14 years between 1993 and 2006 and the improvement of cardiovascular mortality contributed to this with 1.85 years. Lipid lowering therapy and achievement of target lipid levels have become recently a crucial point of cardiovascular prevention. Despite the improving tendency the rate of achieving LDL-cholesterol goal is not higher than 1/3 and its main cause seems to be the fact that greater part of the physicians (56% of them in year 2007) - seeing the results with not convenient lipid levels - yield to it, do not modify the current treatment. However, there is growing evidence that the lower LDL-cholesterol level improves not only the clinical outcome but it is cost-effective as well. The most important trial performed recently using statin was the JUPITER study, in which patients with normal lipid levels and high hs-CRP level without known atherosclerotic disease were treated with 20 mg rosuvastatin or placebo. The primary endpoint (cardiovascular mortality, stroke, non fatal myocardial infarction, unstable angina and revascularization) decreased significantly by 44% and total mortality decreased by 20%. For the prevention of one primary event 23 patients for 5 years were necessary to be treated. The results raise the need for reconsidering principles and target levels of the primary prevention and warn that in the lipid lowering therapy a greater emphasis should be placed on the hs-CRP level.
Békés Megyei Képviselo-testület Pándy Kálmán Kórház II. Belgyógyászat-Kardiológia, Gyula. mark@pandy.hu
László
L
Márk
András
A
Katona
D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000188:drug therapy; D001291:Attitude of Health Personnel; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood*; D018849:Controlled Clinical Trials as Topic; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use*; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008017:Life Expectancy; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011743:Pyrimidines / Q000627:therapeutic use*; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000627:therapeutic use*
D015415:Biomarkers; D008078:Cholesterol, LDL; D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008055:Lipids; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D002097:C-Reactive Protein