hi dose statins are they worth the risk? 
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 hi dose statins are they worth the risk?

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Narrative Review: Lack of Evidence for Recommended Low-Density
Lipoprotein Treatment Targets: A Solvable Problem
 Rodney A. Hayward, MD; Timothy P. Hofer, MD, MSc; and Sandeep Vijan,
MD, MSc

Recent national recommendations have proposed that physicians should
titrate lipid therapy to achieve low-density lipoprotein (LDL)
cholesterol levels less than 1.81 mmol/L (<70 mg/dL) for patients at
very high cardiovascular risk and less than 2.59 mmol/L (<100 mg/dL)
for patients at high cardiovascular risk. To examine the clinical
evidence for these recommendations, the authors sought to review all
controlled trials, cohort studies, and case-control studies that
examined the independent relationship between LDL cholesterol and
major cardiovascular outcomes in patients with LDL cholesterol levels
less than 3.36 mmol/L (<130 mg/dL).

For those with LDL cholesterol levels less than 3.36 mmol/L (<130 mg/
dL), the authors found no clinical trial subgroup analyses or valid
cohort or case-control analyses suggesting that the degree to which
LDL cholesterol responds to a statin independently predicts the degree
of cardiovascular risk reduction. Published studies had avoidable
limitations, such as a reliance on ecological (aggregate) analyses,
use of analyses that ignore statins' other proposed mechanisms of
action, and failure to account for known confounders (especially
healthy volunteer effects). Clear, compelling evidence supports near-
universal empirical statin therapy in patients at high cardiovascular
risk (regardless of their natural LDL cholesterol values), but current
clinical evidence does not demonstrate that titrating lipid therapy to
achieve proposed low LDL cholesterol levels is beneficial or safe.

Thanks Vince



Wed, 02 Jun 2010 22:46:11 GMT
 
 [ 1 post ] 

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