Primary Prevention of Cardiovascular Mortality and Events With Statin Treatments

Mills, Edward J.; Rachlis, Beth; Wu, Ping; Devereaux, P. J.; Arora, Paul; Perri, Dan

doi:10.1016/j.jacc.2008.08.039

Cited by 387 publications

(231 citation statements)

References 68 publications

(114 reference statements)

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“…As expected, the LDL-C, TC and apo B levels were markedly, consistently and significantly decreased after short-term, medium term or long-term statin therapy as compared with baselines, which were consistent with previous reports (22)(23)(24).…”

Section: Discussionsupporting

confidence: 92%

Long-term statin therapy could be efficacious in reducing the lipoprotein (a) levels in patients with coronary artery disease modified by some traditional risk factors

Xu¹,

Liu²,

He³

et al. 2017

J. Thorac. Dis.

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Background: Lipoprotein (a) [Lp (a)] is a well-established risk factor for coronary artery disease (CAD).However, up till now, treatment of patients with higher Lp (a) levels is challenging. This current study aimed to investigate the therapeutic effects of short-, medium and long-term statin use on the Lp (a) reduction and its modifying factors. Methods: The therapeutic duration was categorized into short-term (median, 39 days), medium term (median, 219 days) and long-term (median, 677 days). The lipid profiles before therapy served as baselines.Patients at short-, medium or long-term exactly matched with those at baseline. Every patient's lipid profiles during the follow-ups were compared to his own ones at baselines. Results: The current study demonstrated that long-term statin therapy significantly decreased the Lp (a) levels in CAD patients while short-term or medium term statin therapy didn't. When grouped by statin use, only long-term simvastatin use significantly decreased the Lp (a) levels while long-term atorvastatin use insignificantly decreased the Lp (a) levels. Primary hypertension (PH), DM, low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) could modify the therapeutic effects of statin use on the Lp (a) levels in CAD patients. Conclusions: The long-term statin therapy could be efficacious in reducing the Lp (a) levels in CAD patients, which has been modified by some traditional risk factors. In the era of commercial unavailability of more reliable Lp (a) lowering drugs, our findings will bolster confidence in fighting higher Lp (a) abnormalities both for patients and for doctors.

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Section: Discussionsupporting

confidence: 92%

Long-term statin therapy could be efficacious in reducing the lipoprotein (a) levels in patients with coronary artery disease modified by some traditional risk factors

Xu¹,

Liu²,

He³

et al. 2017

J. Thorac. Dis.

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“…Numerous meta-analyses of primary prevention studies using statins have clearly demonstrated that these drugs provide cardiovascular benefits [14][15][16] . According to a metaanalysis of 20 randomized primary prevention studies with statins that included a total of 63,899 subjects, statin therapy reduced both CVD mortality and the incidence of major cardiovascular events in the study populations 14) . Another meta-analysis of 10 primary prevention studies that included 70,388 subjects found that statins significantly reduced the risk of allcause mortality 16) .…”

Section: Discussionmentioning

confidence: 99%

Can Intensive Lipid-Lowering Therapy Improve the Carotid Intima-Media Thickness in Japanese Subjects Under Primary Prevention for Cardiovascular Disease?: The JART and JART Extension Subanalysis

Daida

Nohara

Hata

et al. 2014

JAT

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Aim: This subanalysis aimed to clarify whether intensive lipid-lowering therapy with statins slows the progression of atherosclerosis in Japanese subjects under treatment for primary prevention of cardiovascular disease. Methods: This was a subanalysis of the Justification for Atherosclerosis Regression Treatment (JART) Study. We compared the efficacy of intensive lipid-lowering therapy and conventional therapy with respect to changes in the mean intima-media thickness (IMT) and serum lipid levels. We also evaluated changes in the mean IMT over 24 months of treatment and assessed the relationship between these changes and reductions in the LDL-C levels using a post-hoc analysis. Results: Intensive lipid-lowering therapy with rosuvastatin was associated with significantly smaller changes in the mean IMT and a greater reduction in the serum lipid levels in comparison to conventional therapy with pravastatin. The average net change in the mean IMT was 0.010 mm (n = 121) at 12 months and −0.004 mm (n = 56) at 24 months. A decrease in LDL-C was found to be associated with a smaller change in the mean IMT (p = 0.0009; Jonckheere-Terpstra trend test). A greater reduction in serum LDL-C was found to be associated with a smaller change in the mean IMT. Similar associations were observed for the serum TC and non-HDL-C levels and LDL-C/HDL-C ratio. There were no notable differences in the incidence of serious adverse events among the LDL-C quartiles. Conclusions: Lowering the LDL-C level with intensive lipid-lowering therapy is associated with reduced changes in the IMT among Japanese subjects at moderate to high risk under treatment for primary prevention. Subjects suitable for primary prevention may receive cardiovascular benefits from intensive lipid-lowering therapy, in association with significantly slower IMT progression than that observed with conventional therapy. J Atheroscler Thromb, 2014; 21:739-754.

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“…In fact, the recent decline in the rate of cardiovascular disease mortality observed in both the United States and the United Kingdom mostly is attributable to reductions in cholesterol levels, followed by blood pressure control and, to a lesser extent, smoking cessation. 23,24 In sharp contrast to the absence of a mortality benefit attributable to aspirin prophylaxis, a robust mortality benefit from reducing lowdensity lipoprotein cholesterol (LDL) levels with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) therapy has been documented in both high-risk 25 and primary prevention 26 populations. A recent, costeffectiveness analysis using Markov-type models suggests that at costs of less than $0.10/day, treating all patients with an LDL level above 130 mg/dl in the United States with statin therapy would yield a net cost-savings through dramatic reductions in cardiovascular disease events.…”

Section: Public Health and Clinical Practice Implicationsmentioning

confidence: 99%

An Aspirin a Day: Are We Barking Up the Wrong Willow Tree?

Krantz¹,

Berger²,

Hiatt³

2010

Pharmacotherapy

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Aspirin, or acetylsalicylic acid, is derived from a substance that accumulates in willow trees. Extracts from the bark and leaves contain salicylic acid, used since the time of the Egyptians for the relief of pain. Over the years, the expression, “an aspirin a day keeps the doctor away” has become embedded in our collective psyche, leading to countless individuals consuming this over‐the‐counter preparation on a daily basis without an adequate understanding of its risk‐benefit profile. The public has received the message for decades from numerous guidelines and the manufacturers of aspirin that aspirin should be taken by all adults at risk for cardiovascular disease events.

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Primary Prevention of Cardiovascular Mortality and Events With Statin Treatments

Abstract: Statins have a clear role in primary prevention of CVD mortality and major events.

Cited by 387 publications

References 68 publications

Long-term statin therapy could be efficacious in reducing the lipoprotein (a) levels in patients with coronary artery disease modified by some traditional risk factors

Long-term statin therapy could be efficacious in reducing the lipoprotein (a) levels in patients with coronary artery disease modified by some traditional risk factors

Can Intensive Lipid-Lowering Therapy Improve the Carotid Intima-Media Thickness in Japanese Subjects Under Primary Prevention for Cardiovascular Disease?: The JART and JART Extension Subanalysis

An Aspirin a Day: Are We Barking Up the Wrong Willow Tree?

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