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Pharmacologic options for aggressive low-density lipoprotein cholesterol lowering: benefits versus risks
1Virginia Commonwealth University and National Clinical Research, Richmond, Virginia 23294, USA. jmckenney@ncrinc.net
The American Journal of Cardiology
|August 16, 2005
Summary
Aggressive lipid-lowering therapy, including potent statins like atorvastatin or rosuvastatin, is crucial for patients at high risk of coronary artery disease (CAD). Combination therapies may be needed to achieve target low-density lipoprotein (LDL) cholesterol levels safely.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Recent trials show benefits of lowering low-density lipoprotein (LDL) cholesterol to <1.81 mmol/L for very high-risk patients.
- Patients with ≥2 risk factors benefit from LDL cholesterol <2.59 mmol/L, with 30% reduction linked to fewer CAD events.
Purpose of the Study:
- To update recommendations for achieving more aggressive lipid-lowering goals.
- To outline strategies for implementing intensified statin therapy and combination treatments.
Main Methods:
- Review of recent end-point trials and National Cholesterol Education Program (NCEP) Expert Panel recommendations.
- Analysis of clinical trial data on potent statins (atorvastatin, rosuvastatin) and combination therapies (colesevelam, ezetimibe, niacin).
Main Results:
- Potent statins or higher doses achieve goals in 50-80% of patients; combination therapy adds 10-15% LDL reduction.
- Myopathy/rhabdomyolysis incidence is <0.1%/<0.01% for most potent statins, except simvastatin.
- No adverse effects observed in trials lowering LDL to <1.81 mmol/L, even as low as 0.67 mmol/L.
Conclusions:
- More aggressive therapies, starting with potent statins, are necessary to meet updated lipid-lowering targets.
- Combination therapies are effective for patients not reaching goals with statins alone.
- Current evidence suggests safety in achieving very low LDL cholesterol levels (<1.81 mmol/L).