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Cholesterol-lowering agents. Statins - for everyone?

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Title: Cholesterol-lowering agents. Statins - for everyone?
Authors: Hadjiphilippou, S
Ray, KK
Item Type: Journal Article
Abstract: Cardiovascular disease (CVD) remains the leading cause of death worldwide. To date, decades of research has established LDL-C (low-density lipoprotein cholesterol) as a causal factor in the development of atherosclerotic CVD. Statin therapy, supported by a broad evidence base, has demonstrated its superior efficacy in reducing LDL-C and subsequent cardiovascular risk. It therefore currently forms the mainstay of lipid-lowering therapy as recommended by international guidelines. Statin therapy is indicated in the secondary prevention of atherosclerotic CVD, as well as genetic causes of dyslipidemia (such as familial hypercholesterolemia). Although this strategy targets those most at risk, it merely addresses those most susceptible and does not account for the fact that most cardiovascular events occur in those at moderate to low risk. In addition, there is evidence for use in primary prevention such as in those with diabetes mellitus, chronic kidney disease, and high risk of future atherosclerotic CVD as determined by risk prediction calculators. Risk prediction tools, however, are far from perfect and do not accurately account for those at low short-term but high lifelong risk. Considering the log-linear relationship between LDL-C reductions and reductions in risk of atherosclerotic CVD, even in those at very low risk of future events, a clinical question posed is can we and should we shift the entire risk distribution by treating everyone? The present review discusses these issues in more detail outlining arguments for and against each approach.
Issue Date: 1-Feb-2019
Date of Acceptance: 16-Oct-2018
URI: http://hdl.handle.net/10044/1/66900
DOI: https://dx.doi.org/10.1161/CIRCRESAHA.118.313245
ISSN: 0009-7330
Publisher: American Heart Association
Start Page: 354
End Page: 363
Journal / Book Title: Circulation Research
Volume: 124
Issue: 3
Copyright Statement: © 2019 American Heart Association, Inc.
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Hematology
Peripheral Vascular Disease
Cardiovascular System & Cardiology
cardiovascular disease
cholesterol
primary prevention
risk factors
secondary prevention
CORONARY-HEART-DISEASE
HIGH-DOSE ATORVASTATIN
14 RANDOMIZED-TRIALS
CARDIOVASCULAR-DISEASE
PRIMARY PREVENTION
MYOCARDIAL-INFARCTION
DIABETES-MELLITUS
FAMILIAL HYPERCHOLESTEROLEMIA
LDL CHOLESTEROL
COST-EFFECTIVENESS
1103 Clinical Sciences
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status: Published
Conference Place: United States
Online Publication Date: 2019-01-31
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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