Reducing morbidity and mortality in high risk patients with statins

Abstract

Residual coronary heart disease remains a significant problem even after adequate statin therapy for cardiovascular risk reduction as currently recommended by the Adult Treatment Panel III (ATP-III) of the National Cholesterol Education Program (NCEP). This is particularly true for the high risk patients as defined by ATP-III that includes those patients who have a greater than 20% 10-year risk of adverse cardiac events. For such patients the current goal of a low-density lipoprotein cholesterol (LDL-cholesterol) maintenance level of < or =100 mg/dL plasma appears to be suboptimal. Accumulating data from several recent randomized studies of more aggressive LDL-cholesterol reduction to levels below 70 mg/dL in the high risk patients favor acceptance of such a new lower target for LDL-cholesterol using more intensive statin therapy which would affect the treatment strategy for patients with coronary heart disease pre-percutaneous intervention, metabolic syndrome, diabetes mellitus, congestive heart failure, cerebrovascular disease and chronic kidney disease.

Keywords: chronic kidney disease; congestive heart failure; coronary atherosclerosis; diabetes; dyslipidemia; high risk patients; intensive statin therapy; metabolic syndrome; pre-percutaneous intervention; statins.

Figure 1

Kaplan-Meier estimates of the incidence of major cardiovascular events in patients with diabetes mellitus (includes congestive heart failure death, non-fatal nonprocedure-related acute myocardial infarction, resuscitated cardiac arrest, and fatal or non-fatal stroke). Abbreviations: HR, hazard ratio; CI, confidence interval.