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Review of cholesterol-lowering therapy: coronary angiographic and events trials
1Hartford Hospital, Connecticut 06102, USA.
Insights
Lowering cholesterol slows atherosclerosis and reduces coronary events. Pooled data show significant reductions in total mortality and nonfatal myocardial infarction (MI) with cholesterol-lowering therapy.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Cholesterol lowering slows atherosclerosis progression and reduces coronary events.
- Atherosclerosis progression is linked to increased risk of cardiac death and myocardial infarction (MI).
Purpose of the Study:
- To summarize the impact of cholesterol-lowering interventions on cardiovascular outcomes.
- To evaluate the effectiveness of lipid-lowering therapy in patients with coronary artery disease (CAD) and hypercholesterolemia.
Main Methods:
- Meta-analysis of coronary angiographic trials.
- Review of landmark studies like Scandinavian Simvastatin Survival Study (4S), West of Scotland Coronary Prevention Study (WOSCOPS), and Cholesterol and Recurrent Events (CARE) Study.
Main Results:
- Pooled data from regression trials showed a 26% reduction in total mortality and 39% reduction in nonfatal MI.
- The 4S study demonstrated reduced coronary mortality, fatal/nonfatal MI, sudden cardiac death, and revascularization needs.
- WOSCOPS and CARE studies confirmed benefits in primary and secondary prevention populations, including those with less severe dyslipidemia.
Conclusions:
- Cholesterol-lowering therapy is effective in slowing atherosclerosis, reducing coronary events, and improving survival in patients with CAD.
- Lipid-lowering interventions provide significant benefits across various patient subgroups, regardless of concomitant therapies.
- Evidence supports the use of cholesterol-lowering therapy for both primary and secondary prevention of cardiovascular disease.
Abstract:
Coronary angiographic trials have demonstrated that the lowering of cholesterol slows the progression of atherosclerosis, enhances atherosclerotic regression, limits the formation of new lesions, and reduces the incidence of coronary events. Atherosclerotic progression has been shown to be associated with an increased risk of cardiac death, cardiac death plus nonfatal myocardial infarction (MI), and all coronary events. Most of the atherosclerotic regression trials were too small and of too short duration to demonstrate a significant difference in hard coronary events between patients receiving cholesterol-lowering intervention and controls. However, when data from these studies were pooled, total mortality was found to be reduced by 26% and the rate of nonfatal MI by 39% in actively treated patients. The first events trial to demonstrate clearly a reduction in overall mortality was the Scandinavian Simvastatin Survival Study (4S), in which lowering of serum cholesterol in patients with coronary artery disease (CAD) and hypercholesterolemia also reduced coronary mortality, fatal and nonfatal MI, sudden cardiac death, and the need for revascularization. Reductions in major coronary events were seen consistently in all subgroups of patients studied and regardless of concomitant therapy with aspirin, beta blockers, or calcium antagonists. Further evidence of the benefit of cholesterol-lowering therapy was provided by the West of Scotland Coronary Prevention Study (WOSCOPS), which evaluated men with hypercholesterolemia but no history of CAD. Those receiving active treatment had less overall mortality, lower risk of definite nonfatal MI or death from definite or suspected CAD, and less need for revascularization. The Cholesterol and Recurrent Events (CARE) Study recently showed that lipid-lowering therapy is also beneficial in CAD patients with less severe dyslipidemia.