Reducing morbidity and mortality in high risk patients with statins

Vibhuti Singh¹, Prakash Deedwania²

¹University of South Florida College of Medicine, and Suncoast Cardiovascular Center, St. Petersburg, Florida, USA; ²Cardiology Division, VACCHCS/UCSF, Fresno, CA, and UCSF School of Medicine, San Francisco, CA, USA

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 ≤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, cerebro-vascular disease and chronic kidney disease.

Keywords: statins, high risk patients, dyslipidemia, intensive statin therapy, metabolic syndrome, diabetes, congestive heart failure, chronic kidney disease, coronary atherosclerosis, pre-percutaneous intervention