THERAPY Statins for secondary prevention: might less in fact be more?

Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Blalock 524C, 600 North Wolfe Street, Baltimore, MD 21287, USA.
Nature Reviews Endocrinology (Impact Factor: 13.28). 03/2011; 7(3):131-2. DOI: 10.1038/nrendo.2011.17
Source: PubMed


Statin therapy following myocardial infarction is a pillar of the secondary prevention approach. however, defining a maximally beneficial dosing strategy requires attention to both cardiovascular outcomes and to the potentially unsavory clinical adverse effects of high-dose therapy.

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    ABSTRACT: Low-density lipoprotein cholesterol (LDL-C) is the lipoprotein most implicated in atherosclerosis, and aggressive statin therapy remains the cornerstone of treatment. Adjunct therapies are often required to reach LDL-C goals, and recent studies have only fueled the debate over ezetimibe versus niacin. Alternate dosing regimens of high-potency statins can be used in those who cannot tolerate side effects. Residual risk may remain after LDL-C goals are achieved. Non–high-density lipoprotein cholesterol (non–HDL-C) must be calculated in patients with elevated triglycerides. Omega-3 fatty acids are most effective in lowering non–HDL-C. Low HDL-C levels can be raised with niacin, but clinical events may not be significantly reduced. Newer therapeutic targets, such as cholesteryl ester transfer protein (CETP) inhibitors, raise HDL-C and are being evaluated for safety and efficacy. Several ongoing, randomized controlled trials are investigating the relative efficacy of adjunctive therapies for reducing coronary heart disease events in high-risk patients. KeywordsLipid management–Coronary heart disease–Atherosclerosis–Adjunct therapy–Statin–Secondary prevention–Niacin–Omega-3 fatty acid–Lipid guidelines–Cholesteryl ester transfer protein inhibitor–Low density lipoprotein–High density lipoprotein–Triglycerides–Non-high density lipoprotein
    Current Cardiovascular Risk Reports 10/2011; 5(5):399-406. DOI:10.1007/s12170-011-0191-3

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