Role of aggressive LDL reduction in patients with coronary heart disease

The aim of the present study was to integrate research evidence with the care of the patient with coronary heart disease (CHD) and place into perspective the importance of intensive statin therapy. We reviewed five major trials and select related post hoc analyses that examined the beneficial effects from intensive low-density lipoprotein (LDL) reduction on combined morbidity and mortality end points in patients with stabilized CHD and those with recent acute coronary syndrome.Accumulating evidence since the publication of the pivotal Heart Protection Study and Adult Treatment Panel III supports a more intensive LDL reduction than that recommended in the 2004 Adult Treatment Panel III update. An LDL reduction of 49% from baseline in statin-naïve patients with stable CHD or a 41% to 44% reduction in LDL from postadmission values in patients with acute coronary syndrome improves composite morbidity and mortality end points.Current evidence suggests that a more intensive LDL reduction of approximately 45% to 50% from a patient's baseline in acute and stable CHD is warranted. The decrease in recurrent events associated with the use of statin regimens that can achieve this degree of reduction in LDL may offer a financial incentive for managed care healthcare systems; however, statin therapy should be selected upon careful consideration of both dose and agent.