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Reducing morbidity and mortality in high risk patients with statins.

Singh V, Deedwania P - Vasc Health Risk Manag (2009)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: University of South Florida College of Medicine, Suncoast Cardiovascular Center, 601 7th Street South, St. Petersburg, FL 33701, USA. vsingh@health.usf.edu

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.

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Related in: MedlinePlus

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.
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f1-vhrm-5-495: 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.

Mentions: High risk patients are defined as those who already have had manifest CHD or CHD equivalents, such as diabetes mellitus (DM), peripheral vascular disease (PVD), cerebrovascular disease (C-VD), or abdominal aortic aneurysm (Figure 1).1 Chronic kidney disease (CKD) is also considered a CHD equivalent condition by some authors. These patients have greater than 20% 10-year risk of acute cardiac events according to the Framingham Heart Study risk score calculations. Patients with features of metabolic syndrome (MS) exhibit similar high risk prognosis. In addition, patients presenting with acute coronary syndrome (ACS), or those pre-percutaneous intervention (pre-PCI), also form a group of high risk patients who appear to derive greater benefit with increasingly more aggressive statin therapy and reduction of LDL-cholesterol to ∼70 mg/dL range.


Reducing morbidity and mortality in high risk patients with statins.

Singh V, Deedwania P - Vasc Health Risk Manag (2009)

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.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2697584&req=5

f1-vhrm-5-495: 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.
Mentions: High risk patients are defined as those who already have had manifest CHD or CHD equivalents, such as diabetes mellitus (DM), peripheral vascular disease (PVD), cerebrovascular disease (C-VD), or abdominal aortic aneurysm (Figure 1).1 Chronic kidney disease (CKD) is also considered a CHD equivalent condition by some authors. These patients have greater than 20% 10-year risk of acute cardiac events according to the Framingham Heart Study risk score calculations. Patients with features of metabolic syndrome (MS) exhibit similar high risk prognosis. In addition, patients presenting with acute coronary syndrome (ACS), or those pre-percutaneous intervention (pre-PCI), also form a group of high risk patients who appear to derive greater benefit with increasingly more aggressive statin therapy and reduction of LDL-cholesterol to ∼70 mg/dL range.

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: University of South Florida College of Medicine, Suncoast Cardiovascular Center, 601 7th Street South, St. Petersburg, FL 33701, USA. vsingh@health.usf.edu

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.

Show MeSH
Related in: MedlinePlus