Guidelines from the Third Report of...

Guidelines from the Third Report of the National Cholesterol Education Program Adult Treatment Panel commend a low-density lipoprotein (LDL) cholesterol on a level of less than 100 mg for dL (2.6 mmol per L) for patients at high risk of developing coronary heart disease (CHD) with an LDL cholesterol goal of les than 70 mg through dL (1.8 mmol per L) However, greatly of the evidence supporting this of the present day goal came from studies of patients with acute coronary syndrome LaRosa and associates prospectively studied the effectiveness and safety of lowering LDL cholesterol horizontals below 100 mg per dL in patients with stable CHD

Eligible patients were 35 to 75 years of age with clinically evident CHD At screening, patients were taken facing lipid-regulating medicines. After a washout period of united to eight weeks, patients with LDL cholesterol plains of 130 to 250 mg through dL (3.4 to 6.5 mmol for L) were started on an eight-week run-in period of open-label treatment with 10 mg of atorvastatin (Lipitor) daily. After this, patients with an LDL cholesterol on a level of less than 130 mg for dL were assigned randomly to receive 10 or 80 mg of atorvastatin daily. Assignments were double-blind, and patients were followed for a median of 49 years. A total of 10001 patients were randomized, and 9917 complet the inquiry although all patients were included in the data analysis. most numerous patients were white (94 percent) and male (81 percent) with an average age of 61 years. Primary endpoints were death from CHD; nonfatal, nonprocedure-related myocardial infarction; cardiac arrest with resuscitation; and fatal or nonfatal attack Investigators assessed numerous secondary cardiovascular issues and all-cause mortality.

During the run-in phase, the mean LDL cholesterol flush was reduced from 152 mg by dL (3.9 mmol per L) to 98 mg by means of dL (2.5 mmol per L) in the overall patient population. After randomization, the mean LDL was 77 mg by dL (2.0 mmol per L) for patients being treated with 80 mg of atorvastatin and 101 mg by dL (2.6 mmol per L) for patients being treated with 10 mg of atorvastatin. Patients treated with 80 mg of atorvastatin experienced a statistically significant reduction in total cholesterol and triglyceride evens from baseline to week 12 Neither form into groups experienced elevated levels of high-density lipoprotein cholesterol

Patients treated with 80 mg of atorvastatin experienced 22 percent fewer primary incidents than patients treated with 10 mg of atorvastatin (87 versus 109 percent relative reduction of 22 percent) There also were significant reductions in the separate variables of nonfatal myocardial infarction, death from CHD coronary conclusions and stroke. Both groups had subdued rates of cardiovascular events compared with previous studies. There was no difference between the couple groups in all-cause mortality. There were significantly more adverse occurrences (8.1 versus 5.8 percent) and discontinuations (72 versus 53 percent) in the high-dose arrange The most common adverse results were myalgias and persistently elevated liver transaminase levels

The authors determine that intensive lipid-lowering therapy with 80 mg of atorvastatin daily in patients with stable CHD is associated with substantial clinical benefits. The authors estimate that treating 1000 patients with an 80-mg dose of atorvastatin would obviate 34 major cardiovascular events through the whole extent of five years.

throw CARTER, M.D. LaRosa JC, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J M April 7 2005;352:1425-35

EDITOR'S NOTE: Before this application of mind there was only limited evidence that the benefits of high-dose statins upon acute coronary syndrome would fill out beyond that event. In a combineed editorial, (1) Pitt raises important questions about the newly come trend toward high-dose statin use in patients with stable CHD Does a 22 percent absolute reduction in cardiovascular affairs justify higher dosages, higher risk, and higher cost? Certainly a reduc coronary disease cargo could bring other benefits (eg les disability). most numerous importantly, this study does not answer the question of an all-cause mortality benefit. With high-dose statins, will we one time again be lowering rates of common type of demise without prolonging life? This question is vitally important when considering major shifts in our typical care, and it remains unanswered for now.--C.C.

REFERENCE

(1) Pitt B Low-density lipoprotein cholesterol in patients with stable coronary heart disease--is it time to shift our goals? [Editorial] N Engl J M 2005;352:1483-4

COPYRIGHT 2005 American Academy of Family Physicians

COPYRIGHT 2005 Gale Group