Statin therapy: where are we? Where do we go next?

Area of Science:

• Cardiology
• Preventive Medicine
• Biochemistry

Background:

• Statin therapy is proven to reduce coronary artery disease (CAD) morbidity and mortality.
• The link between lowering total and low-density lipoprotein cholesterol (LDL-C) and CAD prevention is well-established.
• Accurate global risk assessment requires incorporating factors beyond traditional cholesterol levels.

Purpose of the Study:

• To evaluate the predictive value of on-treatment apolipoproteins B and A-I in patients with average cholesterol levels and reduced high-density lipoprotein cholesterol (HDL-C).
• To highlight the importance of triglycerides and HDL-C in CAD risk assessment.
• To identify challenges in refining global cardiovascular risk assessment for clinical practice.

Main Methods:

• Analysis of outcomes from the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) primary prevention trial.
• Inclusion of patients with average cholesterol levels and low HDL-C.
• Review of data from fibrate therapy trials and other relevant studies.

Main Results:

• On-treatment apolipoproteins B and A-I levels are important predictors of first major cardiovascular events in specific patient populations.
• Triglycerides and HDL-C levels are significant contributors to coronary artery disease risk.
• Existing risk assessment models may not fully capture the global cardiovascular risk.

Conclusions:

• Future treatment guidelines must incorporate novel risk factors like apolipoproteins, triglycerides, and HDL-C for comprehensive CAD risk assessment.
• Refining global risk measurement and simplifying its clinical application are essential.
• Personalized risk assessment considering multiple biomarkers is crucial for effective lifestyle and drug therapy interventions.