Statins and the primary prevention of cardiovascular events

Abstract

Cardiovascular disease remains the leading cause of death in both men and women in the United States. Treating elevated low-density lipoprotein (LDL) cholesterol has been shown to be very effective in reducing the rate of coronary heart disease (CHD) in primary prevention trials; however, the data are not as robust for treating individuals categorized at either lower risk for CHD or with below-average LDL cholesterol levels. The next frontier for investigation will include strategies to determine who in these lower risk categories should be treated with statins. The growing epidemics of obesity, diabetes, and metabolic syndrome also loom as major problems that need to be incorporated into any strategy that focuses on the prevention of cardiovascular disease. In individuals with multiple cardiovascular risk factors, combination therapies tailored to address each individual's risk profile need to be considered to best decrease the likelihood of their first coronary event.

Effect of Lycopene and Tomato Products on Cholesterol Metabolism

“…Control of cholesterol levels through therapeutic drugs have significantly reduced the risk of developing atherosclerosis and associated cardiovascular diseases [7,8,9,10]. Notably, statins, a class of cholesterol-lowering drugs inhibiting cholesterol synthesis, have been most widely prescribed for treating hypercholesterolemia and reducing cardiovascular diseases [8,9,10].…”

“…Notably, statins, a class of cholesterol-lowering drugs inhibiting cholesterol synthesis, have been most widely prescribed for treating hypercholesterolemia and reducing cardiovascular diseases [8,9,10]. However, adverse effects associated with therapeutic drugs, such as myopathy, liver damages and potential drug-drug interaction, have been reported [11,12,13,14,15].…”

New Evidence Extending the Benefit of Treating LDL-C Beyond the Current Guidelines

“…Because of the low absolute event rates in those with both low LDL-C and CRP in AFCAPS/TexCAPS, the JUPITER investigators concluded that overall this group would not benefit from statin therapy, and thus excluded them from the study cohort. However, a post hoc analysis of AFCAPS/ TexCAPS suggested the hypothesis that primary prevention patients at LDL-C goal (ie, <130 mg/dL) but with metabolic syndrome and a CRP geater than 1 mg/L may also benefit from lovastatin therapy (RR 0.62; P=0.315) [14]. Because the number of individuals in this subgroup was small, the statistical benefit was not confirmed but trended toward benefit, thus generating the hypothesis that this may be a subgroup who might benefit from statin therapy.…”

Guías de práctica clínica para el tratamiento de la hipertensión arterial 2007

“…Varios ensayos aleatorizados de prevención secundaria y primaria han permitido analizar el efecto de las intervenciones hipolipemiantes con estatinas [752][753][754] . Aunque los datos epidemiológicos indican que la concentración sérica de colesterol presenta una estrecha asociación con los episodios coronarios pero no con el ictus 755 , las estatinas han resultado eficaces para prevenir tanto los episodios coronarios como los cerebrovasculares, y la prevención de ambos trastornos es similar en pacientes hipertensos y normotensos [752][753][754] .…”

“…Aunque los datos epidemiológicos indican que la concentración sérica de colesterol presenta una estrecha asociación con los episodios coronarios pero no con el ictus 755 , las estatinas han resultado eficaces para prevenir tanto los episodios coronarios como los cerebrovasculares, y la prevención de ambos trastornos es similar en pacientes hipertensos y normotensos [752][753][754] . En el ensayo aleatorizado más amplio realizado hasta el momento con una estatina, el Heart Protection Study 756 , la administración de simvastatina a pacientes con una enfermedad cardiovascular establecida redujo 62e Rev Esp Cardiol.…”