Archief Roodbont

Abstract and Introduction

Abstract

As the primary target of therapy in the management of dyslipidemia, LDL-C has been a central focus for practicing clinicians for more than a decade. National Cholesterol Education Program guidelines encourage physicians to lower LDL-C levels to outlined therapeutic targets on the basis of ongoing randomized controlled trials demonstrating significant benefit in cardiovascular outcomes among primary and secondary prevention individuals. Relevant epidemiological analysis of cardiovascular outcomes in the USA reports that although statin therapy provides a relative risk reduction of 30%, many coronary heart disease patients at the LDL-C target level are still having major events, of which more than half are recurrent. Although statins – the mainstay of therapy – are able to decrease LDL-C by a range of approximately 30–50% depending on the potency and dose of the statin administered, they remain underused in the clinical setting by practicing physicians. There also remains controversy as to whether more intensive lowering of LDL-C provides additional cardiovascular benefit or not. Intensive lowering of LDL-C as it pertains to the incidence of cardiovascular outcomes (including myocardial infarction, coronary revascularization and ischemic stroke) is assessed in this meta-analysis of 170,000 individuals from 26 large, randomized controlled trials. The implications of the Cholesterol Treatment Trialists' Collaboration for practicing physicians are discussed here.

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