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Clinical Question:
Are there evidence that statin is effective in reducing death on patient
with acute and chronic cardiovascular disease?
Bottom Line:
For patients at high risk of coronary artery disease there is growing
evidence for the concept of 'the lower, the better' regarding LDL
cholesterol levels. The target values for LDL cholesterol of less than 1.8
mmol/l (<70 mg/dl) should be considered for all patients with coronary
artery disease or equivalent coronary risk.Ongoing trials are further
investigating the safety of lower target values in patients at various risk
of coronary artery disease.
Reference:
Statin therapy for prevention and treatment of acute and chronic
cardiovascular disease: update on recent trials and metaanalyses.Briel M,
Nordmann AJ, Bucher HC. Curr Opin Lipidol. 2005 Dec;16(6):601-5.
Study Design:
Metaanalysis (Randomized Controlled Trials)
Synopsis:
The author summarized evidence from recent clinical trials and metaanalyses
on the efficacy of statin therapy to reduce death, myocardial infarction and
stroke, and to review the effects of statins in patients with low LDL
cholesterol, diabetes, end-stage renal disease, and acute coronary syndrome.
In large metaanalyses of randomized controlled trials relative risk
reductions from statins compared with placebo for patients with manifest or
with risk factors for coronary artery disease were 13% for overall
mortality, 26% for fatal and nonfatal myocardial infarction, and 18% for
fatal and nonfatal stroke. Evidence from large trials suggests that patients
with type II diabetes compared with patients without diabetes have similar
risk reductions from statins for cardiovascular events, but this benefit is
not seen in patients with diabetes and end-stage renal disease. In patients
with acute coronary syndrome, early treatment with high-dose atorvastatin
reduces cardiovascular morbidity after the first 4 months following the
event, but the impact on mortality endpoints remains less clear. Results
from recent trials in patients with stable coronary artery disease or type
II diabetes suggest that statins provide benefit at considerable low LDL
cholesterol levels. Therefore, target values for LDL cholesterol of less
than 1.8 mmol/l (<70 mg/dl) should be considered for all patients with
coronary artery disease or equivalent coronary risk. |