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
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
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