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2003, Number s1

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Arch Cardiol Mex 2003; 73 (s1)

Benefits from the intensive reduction of low density lipoproteins-cholesterol

Posadas RC
Full text How to cite this article

Language: Spanish
References: 9
Page: 116-120
PDF size: 55.92 Kb.


Key words:

Coronary events, Cholesterol lowering, Benefits.

ABSTRACT

The role of elevated cholesterol in the initiation and progression of atherosclerosis is universally recognized. In the last 14 years, the inhibitors of the 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG CoA) reductase (statins) have become one of the most widely used therapeutic agents to lower cholesterol levels. Individual large clinical trials, as well as a meta-analysis of five of these studies, have clearly demonstrated the effect of statin-induced low-density lipoprotein cholesterol (LDL-C) lowering in significantly reducing the risk of coronary events in patients with a history of coronary artery disease (CAD). However, there are a few remaining questions, and the most important uncertainty is to what extent should cholesterol be reduced? The results of three large ongoing trials, specifically designed to answer this question, will be available in about two years. In the meantime, this paper presents a short review of the data derived from epidemiological studies and large intervention trials, suggesting that, in patients at high risk, the lower the LDL-C induced by treatment, the better the chance of reducing the incidence of cardiovascular events.


REFERENCES

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  2. Cullen P, Assmann G: Treatment goals for low-density lipoprotein cholesterol in the secondary prevention of coronary heart disease: absolute levels or extent of lowering? Am J Cardiol 1997; 80: 1287-1294.

  3. Pedersen TR, Olsson AG, Faergeman O, Kjekshus J, Wedel H, Berg K, et al: Lipoprotein changes and reduction in the incidence of major coronary heart disease events in the Scandinavian Simvastatin Survival Study (4S). Circulation 1998; 97: 1453-1460.

  4. Sacks FM, Moye LA, Davis BR, Cole TG, Rouleau JL, Nash DT, et al: Relationship between plasma LDL concentrations during treatment with pravastatin and recurrent coronary events in the Cholesterol and Recurrent Events trial. Circulation 1998; 97: 1446-1452.

  5. Grundy SM: Statin trials and goals of cholesterol-lowering therapy. Circulation 1998; 97: 1436-1439.

  6. Knatterud GL, Rosenberg Y, Campeau L, Geller NL, Hunninghake DB, Forman SA, et al: Long-term effects on clinical outcomes of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation in the post coronary artery bypass graft trial. Circulation 2000, 11; 102: 157-165.

  7. Heart Protection Study Collaborative Group: MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomized placebo-controlled trial. Lancet 2002; 360: 7-22.

  8. West of Scotland Coronary Prevention Study Group: Influence of pravastatin and plasma lipids on clinical events in the West of Scotland Coronary Prevention Study (WOSCOPS). Circulation. 1998; 97: 1440-1445.

  9. Davidson MH: Statin trials in progress: unanswered questions. Curr Atheroscler Rep 2001; 3: 9-13.




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C?MO CITAR (Vancouver)

Arch Cardiol Mex. 2003;73