Intensive Lipid-Lowering Therapy in Patients with Coronary Heart Disease

OBJECTIVE: To describe current data evaluating the use of intensive lipid-lowering therapy in patients with coronary heart disease. DATA SOURCES: A literature search using MEDLINE (1966–September 2004) was conducted using the search terms lipoproteins, low-density lipoprotein cholesterol (LDL-C), hydroxymethylglutaryl-coenzyme A reductase inhibitors, coronary arteriosclerosis, and coronary disease to identify published trials comparing the effects of intensive and conventional lipid-lowering therapy. DATA SYNTHESIS: Intensive lipid-lowering therapy reduces LDL-C levels significantly more than conventional treatment and appears to reduce cardiovascular morbidity and mortality in patients who have recently experienced acute coronary syndrome (ACS). However, evidence suggesting clinical benefits in patients with stable coronary heart disease is currently lacking. CONCLUSIONS: Although data are limited, patients with ACS may benefit from intensive lipid-lowering therapy. Several studies are underway to determine the appropriate role of intensive lipid-lowering therapy.

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Lipid-Lowering Therapy in Patients with Coronary Heart Disease and Prior Stroke: Mission Impossible?

Journal of Clinical Medicine ◽

10.3390/jcm10040886 ◽

2021 ◽

Vol 10 (4) ◽

pp. 886

Author(s):

Pier Luigi Temporelli ◽

Marcello Arca ◽

Laura D’Erasmo ◽

Raffaele De Caterina

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipid Lowering ◽

Atherosclerotic Cardiovascular Disease ◽

Lipid Lowering Therapy ◽

Lowering Therapy ◽

Lipid Guidelines ◽

Coronary Events

Hyperlipidemia is a powerful risk factor for coronary heart disease (CHD). It has been known for a long time that lipid-lowering drugs significantly reduce morbidity from CHD, thus proving a causal role for cholesterol in coronary events. Conversely, the relationship between low-density lipoprotein cholesterol (LDL-C) levels and stroke has been less clear and debated for many years. Recent data conclusively demonstrate not only the inverse epidemiological relationship of blood LDL-C with stroke, but also the efficacy of different strategies to attain cholesterol-lowering on stroke. They also dissipate lingering doubts about the possibility that lipid-lowering is linked to an increase in hemorrhagic stroke. However, despite current international lipid guidelines now strongly recommend aggressive lipid-lowering therapy in patients with atherosclerotic cardiovascular disease, including CHD and cerebrovascular disease (CeVD), secondary prevention patients are often undertreated with lipid-lowering therapies in routine clinical practice. This review highlights that patients with CHD and concomitant CeVD do not receive aggressive lipid-lowering therapy despite being at very high risk and with clear evidence of benefit from lowering LDL-C levels below current targets.

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Real-World Effectiveness of Lipid-Lowering Therapy in Male and Female Outpatients with Coronary Heart Disease: Relation to Pre-Treatment Low-Density Lipoprotein-Cholesterol, Pre-Treatment Coronary Heart Disease Risk, and other Factors

European Journal of Cardiovascular Prevention & Rehabilitation ◽

10.1177/204748730501200106 ◽

2005 ◽

Vol 12 (1) ◽

pp. 37-45 ◽

Cited By ~ 17

Author(s):

Karl J. Krobot ◽

Donald D. Yin ◽

Evo Alemao ◽

Elisabeth Steinhagen-Thiessen

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

Lowering Therapy ◽

Pre Treatment

Background Determinants of the real-world effectiveness of lipid-lowering therapy have been rarely assessed in an unselected observational coronary heart disease (CHD) community cohort over time. Design Randomly drawn patients (n = 605) from randomly drawn practices (n = 62) were retrospectively followed for a median of 3.6 years (1998-2002) on lipid-lowering therapy (98% statins). Methods Coronary heart disease population-averaged estimates and variances accounting for repeated measurements within patients were obtained using generalized estimating equations. Results Post-treatment low-density lipoprotein-cholesterol (LDL-C) was 124 mg/dl in men and 141 mg/dl in women and was independently associated (all P<0.05) with pre-treatment LDL-C (+ 3.7 mg/dl per 10 mg/dl increment), female sex (+ 14.0 mg/dl), coronary bypass (-9.5 mg/dl), drug-treated diabetes mellitus (-6.8 mg/dl), and era 2002/2001 versus 1999/2000 (- 6.4 mg/dl) in age-adjusted multivariate analyses. Holding pre-treatment LDL-C constant post-treatment LDL-C was associated with pre-treatment Framingham CHD risk in men (- 13.9 mg/dl per doubling of risk), whereas LDL-C control in women resembled that in low-risk men. The likelihood of attaining LDL-C < 100 mg/dl was 0.28 in men and 0.17 in women and was likewise associated with the above factors. Conclusion Low-density lipoprotein-cholesterol control remained low despite lipid-lowering therapy across a wide range of pre-treatment LDL-C and pre-treatment CHD risk. Low-density lipoprotein-cholesterol control in women was inferior to that in men, a finding that warrants attention and clarification. Eur J Cardiovasc Prev Rehabil 12:37-45 © 2005 The European Society of Cardiology

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Predictors of LDL-cholesterol target value attainment differ in acute and chronic coronary heart disease patients: Results from DYSIS II Europe

European Journal of Preventive Cardiology ◽

10.1177/2047487318806359 ◽

2018 ◽

Vol 25 (18) ◽

pp. 1966-1976 ◽

Cited By ~ 19

Author(s):

Jean Ferrieres ◽

Gaetano Maria De Ferrari ◽

Michel P. Hermans ◽

Moses Elisaf ◽

Peter P. Toth ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Density Lipoprotein ◽

International Study ◽

Blood Cholesterol ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Treatment Needs ◽

Target Attainment ◽

Coronary Syndrome

Background Patients with coronary heart disease (CHD) and survivors of acute coronary syndrome (ACS) are at very high risk for adverse cardiovascular events. Lowering low-density lipoprotein cholesterol (LDL-C) can reduce the risk, with effective lipid-lowering therapy (LLT) readily available; however, dyslipidemia remains prevalent throughout Europe. Design The observational Dyslipidemia International Study II (DYSIS II) aimed to identify unmet treatment needs in adult ACS and CHD patients. Data for the seven participating European countries are presented herein. Methods The study was carried out from December 2012 to November 2014. Use of LLT and attainment of European-guideline-recommended LDL-C targets were assessed. For ACS patients, changes in lipid levels and LLT were evaluated 4 months post-hospitalization. Results Of the 4344 patients enrolled, 2946 were attending a physician visit for the assessment of stable CHD, while 1398 had been hospitalized for an ACS event. In both patient sets, mean LDL-C levels were high (89.5 and 112.5 mg/dl, respectively) and <70 mg/dl target attainment extremely poor. The mean daily statin dosage (normalized to atorvastatin potency) was 27 ± 20 mg for CHD and 22 ± 17 mg for ACS patients. Treatment was intensified slightly for ACS subjects after hospitalization, with the dosage reaching 35 ± 24 mg/day. LDL-C target attainment was higher by the end of the 4-month follow up (30.9% and 41.5% for patients on LLT and without LLT at baseline, respectively; p < 0.05). Conclusion Elevated blood cholesterol levels are highly prevalent across Europe, with low numbers of coronary patients reaching their recommended LDL-C target. While use of LLT is widespread, there is significant scope for intensifying treatment.

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