Wilbert S. Aronow, MD, FACC, FAHA, AGSF, Department of Medicine, Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care, New York Medical College, Valhalla, NY, USA.
Randomized, double-blind, placebo-controlled studies and observational studies have documented that statins reduce mortality and major cardiovascular events in high-risk persons with hypercholesterolemia. The Heart Protection Study showed that statins reduced mortality and major cardiovascular events in high-risk persons regardless of the initial level of serum lipids, age, or gender. The updated National Cholesterol Education Program (NCEP) III guidelines state that in very-high-risk patients, a serum low-density lipoprotein (LDL) cholesterol level of <1.81 mmol/L (<70 mg/dL) correct is a reasonable clinical strategy, regardless of age. When a high-risk person has hypertriglyceridemia or low serum high-density lipoprotein cholesterol, consideration can be given to combining a fibrate or nicotinic acid with an LDL cholesterol–lowering drug. For moderately high-risk persons, the serum LDL cholesterol should be reduced to <2.59 mmol/L 2.59 (<100 mg/dL). When LDL cholesterol–lowering drug therapy is used to treat high-risk persons or moderately high-risk persons, the serum LDL cholesterol should be reduced by at least 30–40%. High-risk older persons should be treated with lipid-lowering drug therapy according to NCEP III updated guidelines to reduce cardiovascular morbidity and mortality. The LDL cholesterol should be reduced to <4.14 mmol/L (<160 mg/dL)correct in persons at low risk for cardiovascular disease.
Key words: lipids, statins, lipid-lowering drugs, atherosclerotic vascular disease.