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[Drug therapy of hyperlipidemia. Current status in Germany]
1Zentrum Innere Medizin-Schwerpunkt Kardiologie, AG Präventive Kardiologie, Philipps-Universität Marburg. Juergen.Schaefer@mailer.uni-marburg.de
Insights
Statins effectively lower cholesterol and prevent cardiovascular events in high-risk patients. However, their widespread use necessitates careful consideration of side effects and contraindications to ensure patient safety.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Context:
- Hyperlipidemia is a primary risk factor for coronary artery disease (CAD).
- Cholesterol lowering is critical for cardiovascular disease prevention.
- Statins are widely prescribed for lipid-lowering therapy.
Purpose:
- To review the benefits and risks of statin therapy in managing hyperlipidemia.
- To highlight the importance of monitoring side effects and contraindications.
Summary:
- Statins have demonstrated significant efficacy in reducing cardiovascular events, with a number needed to treat (NNT) of 13 for high-risk patients.
- Despite their benefits, the broad application of statins has been accompanied by concerns regarding side effects and inadequate consideration of contraindications.
- The withdrawal of cerivastatin underscores the need for careful drug management and clinical endpoint studies.
Impact:
- Emphasizes the need for a balanced approach to statin therapy, weighing benefits against potential risks.
- Highlights the importance of pharmacovigilance and adherence to safety guidelines in lipid-lowering drug treatment.
- Informs clinical practice regarding the appropriate use of statins in hyperlipidemia management.
Background:
Hyperlipidemia is an important, maybe the most important, risk factor for coronary artery disease (CAD). Therefore lowering elevated cholesterol is crucial for primary and secondary prevention. Dietary treatment but also drug therapy is frequently used to lower cholesterol in our days.
Statins:
Drug therapy with statins has shown to be beneficial in clinical studies. Patients at a high risk for CAD will benefit mostly of drug treatment with a statin and in one out of 13 high-risk patients statin treatment will prevent one serious cardiovascular event [NNT (number needed to treat) = 13]. This is the reason for the success story of statins in the last decade. In Germany more than 700 million defined daily doses of lipid-lowering drugs are prescribed per year, which is sufficient for continuous treatment of 1.9 million patients. However, the broad use of statins came along with some thoughtlessness towards side effects. Safety laboratory values were not determined, contraindications were not considered to be serious enough and the lack of clinical endpoint studies was neglected. In addition there was an attempt to disregulate statins as "over the counter drugs" in the US--an attempt which was stopped by the intervention of the FDA. This practice ended in a series of severe side effects and led to the withdrawal of cerivastatin, a new statin from the market. If this will influence the drug treatment of hyperlipidemia needs to be seen.