Abstract
The newest guidelines for treating people with coronary artery disease (CAD) suggest
benefit from statin-induced LDL cholesterol lowering regardless of baseline LDL cholesterol
level. These guidelines were based on recent clinical trials that showed statistically
significant statin-induced relative risk reductions (RRR) in cardiovascular events.
However, there are proven “non-statin” anti-atheroscleroic treatments. This analysis
was designed to allow the physician to decide which patients benefit from the various
anti-atherosclerotic treatments available. Analysis is presented as absolute risk
reduction (ARR) because ARR takes baseline risk into account. There was a large benefit
from statin therapy in stable CAD when LDL cholesterol levels were high. There were
diminishing returns, despite statistically significance, with statin treatment of
people with chronic CAD and lower LDL cholesterol levels. People with chronic CAD
and lower LDL cholesterol levels had at least as much and possibly twice the ARR when
treated with niacin or gemfibrozil as that would occur with statin treatment. For
the first year after the acute coronary syndrome, risk was higher than in stable CAD,
and trials showed a benefit especially with a Mediterranean diet and also with statin
therapy that reduced LDL cholesterol levels to ∼80 mg dl−1. The Mediterranean diet was also beneficial in chronic CAD. These results suggest
that both statin and non-statin therapy are important for reducing the sequelae of
atherosclerosis.
Keywords
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References
- Intensive lipid lowering with atorvastatin in patients with stable coronary disease.N Engl J Med. 2005; 352: 1425-1435
- High-dose atorvastatin vs. usual dose simvastatin for secondary prevention after myocardial infarction.JAMA. 2005; 294: 2437-2445
- Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.Lancet. 2005; 366: 1267-1278
- Meta-analyses of randomized controlled trials.N Engl J Med. 1987; 316: 450-455
- Using numerical results from systematic reviews in clinical practice.Ann Intern Med. 1997; 126: 712-720
- Medical research council trial in the treatment of hypertension in older adults: principal results.Br Med J. 1992; 304: 405-412
- A number needed to treat (NNT) analysis of the prevention of myocardial infarction and death by dyslipidemic therapy.J Fam Prac. 1996; 42: 577-586
- Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).Lancet. 1994; 344: 1383-1389
- Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels.N Engl J Med. 1998; 339: 1349-1357
- The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels.N Engl J Med. 1996; 335: 1001-1009
- MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial.Lancet. 2002; 360: 7-22
- Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial.Lancet. 2004; 364: 685-696
- Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia.N Engl J Med. 1995; 333: 1301-1307
- Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels—results of AFCAPS/TexCAPS.JAMA. 1998; 279: 1615-1622
- Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial.Lancet. 2002; 360: 1623-1630
- Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial.Lancet. 2003; 361: 1149-1158
- Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease.Lancet. 1994; 343: 1454-1459
- Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction—final report of the Lyon Diet Heart Study.Circulation. 1999; 99: 779-785
- Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia.N Engl J Med. 1990; 323: 946-955
- Dietary supplementation with n-3 polyunsaturated fatty acids and Vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial.Lancet. 1999; 354: 447-455
- Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol.N Engl J Med. 1999; 341: 410-418
- Clofibrate and niacin in coronary heart disease.JAMA. 1975; 231: 360-381
- Intensive versus moderate lipid lowering with statins after acute coronary syndromes.N Engl J Med. 2004; 350: 1495-1504
- Early intensive vs. a delayed conservative simvastatin strategy in patients with acute coronary syndromes—phase Z of the A to Z trial.JAMA. 2004; 292: 1307-1316
- High density lipoproteins (HDLs) and atherosclerosis; the unanswered questions.Atherosclerosis. 2003; 168: 195-211
- The epidemiology of atherosclerotic disease.Harvard University Press, Cambridge, MA1980
- Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high-levels of apolipoprotein-B.N Engl J Med. 1990; 323: 1289-1298
- Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.N Engl J Med. 2001; 345: 1583-1592
- Effects of prolonged intensive lipid-lowering therapy on the characteristics of carotid atherosclerotic plaques in vivo by MRI—a case-control study.Arterioscler Thromb Vasc Biol. 2001; 21: 1623-1629
- A randomized trial of a strategy for increasing high-density lipoprotein cholesterol levels: Effects on progression of coronary heart disease and clinical events.Ann Intern Med. 2005; 142: 95-104
Article info
Publication history
Published online: October 25, 2006
Accepted:
September 13,
2006
Received in revised form:
August 16,
2006
Received:
May 10,
2006
Footnotes
☆There was no funding for this project.
Identification
Copyright
© 2006 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
