[en] Statins, the most popular lipid-lowering agents, have proven their efficacy in preventing cardiovascular events in subjects with lower and lower initial plasma cholesterol levels. Besides, the protective effect does not seem to be directly related neither to the degree of the cholesterol reduction nor to the final level of plasma cholesterol level reached under treatment. Such observations suggest that statins may exert vascular protective effects, at least in part, independently of their specific cholesterol-lowering effect (so-called pleiotropic effects). The present paper will discuss the arguments pro and contra the dosage of cholesterolaemia before initiating a therapy with statin and during treatment follow up, both in subjects with previous cardiovascular events (secondary prevention) and in subjects with a high cardiovascular absolute risk but without previous clinical expression of atherosclerosis (primary prevention).
Disciplines :
Pharmacy, pharmacology & toxicology Cardiovascular & respiratory systems
Author, co-author :
Scheen, André ; Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques - Médecine interne générale
Kulbertus, Henri ; Université de Liège - ULiège > Services généraux (Faculté de médecine) > Relations académiques et scientifiques (Médecine)
Language :
French
Title :
Prevention cardio-vasculaire par les statines: faut-il encore doser le cholesterol?
Alternative titles :
[en] Statins for cardiovascular prevention: is there still a place for cholesterol measurement?
Publication date :
2003
Journal title :
Revue Médicale de Liège
ISSN :
0370-629X
eISSN :
2566-1566
Publisher :
Université de Liège. Revue Médicale de Liège, Liège, Belgium
Scheen AJ. - Le risque cardio-vasculaire lié à l'hypercholestérolémic: d'un continuum à la notion de normalité, de seuil d'intervention et d'objectif thérapeutique. Rev Med Liège, 1999, 54, 17-21.
Scheen AJ, Rorive G, Kulbertus H. - Comment j'explore ... le risque coronarien individuel extrapolé à 10 ans. Rev Med Liège, 1999, 54, 118-121.
Task Force Report. - Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Eur Heart J, 1998, 19, 1434-1503.
Ducobu J, Scheen AJ. - Les recommandations du Belgian Lipid Club pour le diagnostic et le traitement des hyperlipidémies: résumé pour le praticien. Rev Med Liège, 2000, 55, 360-366.
Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. - Executive Summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA, 2001, 285, 2486-2497.
Scheen AJ. - Les statines: du récepteur LDL à la protection cardio-vasculaire. Rev Med Liège, 1996, 51, 95-99.
Jones P, Kafonek S, Laurora I, Hunninghake D. - Comparative dose efficacy study of atorvastatin versus simvastatin, pravastatin, lovastatin and fluvastatin in patients with hypercholesterolemia (the CURVES Study). Am J Cardiol, 1998, 81, 582-587.
Heller FR. - Prevention of cardiovascular events by hypolipidemic therapy: evidence-based medicine criteria. Acta Clin Belg, 1999, 54, 299-301.
Kreisberg RA, Oberman A. - Lipids and atherosclerosis: lessons learned from randomized controlled trials of lipid lowering and other relevant studies. J Clin Endocrinol Metab, 2002, 87, 423-437.
Plutzky J, Ridker PM. - Statins for stroke: the second story? Circulation, 2001, 103, 348-350.
Heart Protection Study Collaborative Group. - MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high risk individuals. Lancet, 2002, 360, 7-22.
Smith SC, Blair SN, Bono RO, et al. - AHA/ACC Guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update. Circulation, 2001, 104, 1577-1579.
Gotto AM, Grundy SM. - Lowering LDL cholesterol. Questions from recent meta-analyses and subset analyses of clinical trial data issues from the Interdisciplinary Council on Reducing the Risk for Coronary Heart Disease. Ninth Council Meeting. Circulation, 1999, 99, E1-E7.
Bonetti PO, Lerman LO, Napoli C, Lerman A. - Statin effects beyond lipid lowering-are they clinically relevant? Eur Heart J, 2003, 24, 225-248.
Scheen AJ. - De l'inapplicabilité de certaines recommandations thérapeutiques en pratique: l'exemple du remboursement des médicaments hypolipidémiants en Belgique. Rev Med Liège, 2000, 55, 260-264.
Anderson KM, Castelli WP, Levy DL. - Cholesterol and mortality: 30 years of follow-up from the Framingham Study. JAMA, 1987, 257, 2176-2180.
Stamler L, Wentworth D, Neaton JD. - Is the relationship between serum cholesterol and risk of premature death from coronary heart disease continuous or graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention trial (MRFIT). JAMA, 1986, 256, 2823-2828.
Assmann G, Schulte H, Funke H, von Eckardstein A. - The emergence of triglycerides as a significant independent risk factor in coronary artery disease. Eur Heart J, 1998, Suppl M, M8-M14.
Scandinavian Simvastatin Survival Study Group. - Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet, 1994, 344, 1383-1389.
Sacks FM, Pfeffer MA, Moye LA, et al. - The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med, 1996, 335, 1001-1009.
The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. - Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med, 1998, 339, 1349-1357.
Schwartz G, Olsson AG, Ezekowitz MD, et al. - Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL Study: a randomized controlled trial. JAMA, 2001, 285, 1711-1718.
Serruys PWJC, de Feyter P, Macaya C, et al for the Lescol Intervention Prevention Study (LIPS) Investigators. - Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention. A randomized controlled trial. JAMA, 2002, 287, 3215-3222.
Shepherd J, Cobbe SM, Ford I, et al. - Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med, 1995, 333, 1301-1307.
Dows JR, Clearfield M, Weis S, et al. - Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. JAMA, 1998, 279, 1615-1622.
Kulbertus H, Scheen AJ. - L'étude clinique du mois. La MRC/BHF Heart Protection Study. Rev Med Liège, 2002, 57, 613-616.
The ALLHAT Officiers and Coordinators for the ALL-HAT Collaborative Research Group. - Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA, 2002, 288, 2998-3007.
Sever PS, Dahlöf B, Poulter NR, et al for the ASCOT investigators. - Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet, 2003, 361, 1149-1158.
Grundy SM. - Statin trials and goals of cholesterol-lowering therapy. Circulation, 1998, 97, 1436-1439.
Forrester JS, Bairey-Merz CN, Kaul S. - The aggressive low density lipoprotein lowering controversy. J Am Coll Cardiol, 2000, 36, 1419-1425.
Jacobson TA. - "The lower the better" in hypercholesterolemia therapy: a reliable clinical guideline? Ann Intern Med, 2000, 133, 549-554.
Kulbertus H, Scheen AJ. - L'étude clinique du mois. L'étude ALLHAT-LLT. Rev Med Liège, 2003, 58, 53-58.
Oliver MF, Pyörälä K, Shepherd J. - Evidence-based cardiology. Management of hyperlipidaemia. Why, when and how to treat. Eur Heart J, 1997, 18, 371-375.
Buchwalder P-A, Vogt N, Dayer P. - A qui prescrire des statines? Med Hyg, 1999, 57, 785-792.
Scheen AJ. - La non-observance thérapeutique, problème majeur pour la prévention des maladies cardiovasculaires. Rev Med Liège, 1999, 54, 914-920.
Scheen AJ. - Pharmaco-économie des médicaments hypolipidémiants: analyse des facteurs influençant le rapport coût/efficacité. Rev Med Liège, 1998, 53, 220-222.
British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, British Diabetic Association. - Joint British recommendations on prevention of coronary heart disease in clinical practice: summary. BMJ, 2000, 320, 705-708.
Similar publications
Sorry the service is unavailable at the moment. Please try again later.
This website uses cookies to improve user experience. Read more
Save & Close
Accept all
Decline all
Show detailsHide details
Cookie declaration
About cookies
Strictly necessary
Performance
Strictly necessary cookies allow core website functionality such as user login and account management. The website cannot be used properly without strictly necessary cookies.
This cookie is used by Cookie-Script.com service to remember visitor cookie consent preferences. It is necessary for Cookie-Script.com cookie banner to work properly.
Performance cookies are used to see how visitors use the website, eg. analytics cookies. Those cookies cannot be used to directly identify a certain visitor.
Used to store the attribution information, the referrer initially used to visit the website
Cookies are small text files that are placed on your computer by websites that you visit. Websites use cookies to help users navigate efficiently and perform certain functions. Cookies that are required for the website to operate properly are allowed to be set without your permission. All other cookies need to be approved before they can be set in the browser.
You can change your consent to cookie usage at any time on our Privacy Policy page.