This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Steinberg, D. Articles by Witztum, J. L. Search for Related Content PubMed PubMed Citation Articles by Steinberg, D. Articles by Witztum, J. L. Related Collections Primary prevention Pathophysiology Risk Factors Lipid and lipoprotein metabolism

(Circulation. 2008;118:672-677.)
© 2008 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Evidence Mandating Earlier and More Aggressive Treatment of Hypercholesterolemia

Daniel Steinberg, MD, PhD; Christopher K. Glass, MD, PhD; Joseph L. Witztum, MD

From the Department of Medicine, University of California San Diego, La Jolla.

Correspondence to Dr Daniel Steinberg, Department of Medicine, BSB 1080, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093–0682. E-mail dsteinberg@ucsd.edu

Key Words: atherosclerosis • hypercholesterolemia • inflammation • myocardial infarction • prevention

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The long-standing controversy over the validity of the lipid hypothesis of atherosclerosis has been settled.^1–3 In several large-scale, 5-year trials, statins have reduced coronary heart disease (CHD) morbidity and mortality by 30%, and the magnitude of the protective effect mirrored the magnitude of the low-density lipoprotein (LDL) lowering.⁴ However, as has been quite correctly pointed out,^5,6 some 70% of those expected to have an event (based on the number of events in the control group) went on to have one during the 5 years of the trial despite statin therapy. For example, in the Scandinavian Simvastatin Survival Study, 502 events occurred in the untreated group and 353 in the statin-treated group. The number of events prevented (n=149), as a percentage of the number expected, was 29.7% (149/502x100); the number of events in the statin group that were not prevented (353) amounts to 70.3% (353/502x100). Looked at this way, the results are admittedly not quite so impressive. In fact, some investigators are now taking the position that we can expect to achieve higher salvage rates only if we supplement LDL-lowering therapies with alternative interventions such as the use of antiinflammatory agents or immunotherapy. This may turn out to be true. However, it is much too early to reach that conclusion for reasons we discuss here. The search for alternative or supplementary therapies is already in full swing and should continue.^6–8 We are confident that one day these additional therapies will take their place alongside cholesterol-lowering agents in . . . [Full Text of this Article]

This article has been cited by other articles:

				L. Mascitelli, F. Pezzetta, and M. R Goldstein Letter to the Editor American Journal of Lifestyle Medicine, September 1, 2009; 3(5): 410 - 411. [PDF]

				M. L. Mestek Physical Activity, Blood Lipids, and Lipoproteins American Journal of Lifestyle Medicine, July 1, 2009; 3(4): 279 - 283. [Abstract] [PDF]

				D. Steinberg and J. L. Witztum Inhibition of PCSK9: A powerful weapon for achieving ideal LDL cholesterol levels PNAS, June 16, 2009; 106(24): 9546 - 9547. [Full Text] [PDF]

				K. Stoletov, L. Fang, S.-H. Choi, K. Hartvigsen, L. F. Hansen, C. Hall, J. Pattison, J. Juliano, E. R. Miller, F. Almazan, et al. Vascular Lipid Accumulation, Lipoprotein Oxidation, and Macrophage Lipid Uptake in Hypercholesterolemic Zebrafish Circ. Res., April 24, 2009; 104(8): 952 - 960. [Abstract] [Full Text] [PDF]

				K. K. Koh and M. J. Quon Letter by Koh and Quon Regarding Article, "Evidence Mandating Earlier and More Aggressive Treatment of Hypercholesterolemia" Circulation, March 31, 2009; 119(12): e376 - e376. [Full Text] [PDF]

				D. Steinberg, C. K. Glass, and J. L. Witztum Response to Letter Regarding Article, "Evidence Mandating Earlier and More Aggressive Treatment of Hypercholesterolemia" Circulation, March 31, 2009; 119(12): e377 - e377. [Full Text] [PDF]

				D. H. Newman and D. Steinberg The Statins in Preventive Cardiology N. Engl. J. Med., January 29, 2009; 360(5): 541 - 542. [Full Text] [PDF]

				D. Steinberg The Statins in Preventive Cardiology N. Engl. J. Med., October 2, 2008; 359(14): 1426 - 1427. [Full Text] [PDF]

				D. Steinberg Statin Treatment Does Not Cause Cancer J. Am. Coll. Cardiol., September 30, 2008; 52(14): 1148 - 1149. [Full Text] [PDF]