Protecting the Heart: A Practical Review of the Statin Studies

H. T. Ong, MBBS (Mal), MRCP (UK), M Med (Sing), FRCP (Glasg, Edin), FCCP (USA), FAMM (Mal)

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Conclusion

It is important to seek useful lessons for the practicing physician from these statin trials on hyperlipidemia. The beneficial effect of statin therapy in reducing adverse cardiovascular events, as well as reducing coronary mortality and total mortality in high-risk patients, is overwhelming. There has to be a change in emphasis away from the concept of a "normal lipid profile." Instead, the emphasis should be on risk factors predisposing to coronary disease. The actual threshold for the initiation of therapy varies, but the principle remains the same.[13,14,15,50] The higher the risk, assessed from prior atheromatous disease, diabetes, blood pressure, smoking status, age, and sex, besides the lipid levels, the greater the need to treat and to treat aggressively. Whether statins work by reducing lipid levels or by plaque stabilization or an anti-inflammatory effect is a matter for future researchers to resolve. Present clinicians need to place less emphasis on lipid levels and more importance on risk stratification of the patient. Indeed, a case can be made for all patients with a prior atheromatous disease to be on a statin, regardless of their initial cholesterol level. Equally important, extrapolating especially from the primary prevention trials, the patient not at high risk of cardiovascular events should not be treated merely because of an abnormal lipid profile, as there will not be any significant mortality reduction.

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