High- Versus Low-Dose Statin
Effects on Cardiovascular Events and All-Cause Death
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- carotid artery diseases
- hydroxymethylglutaryl-CoA reductase inhibitors
- lipoproteins, LDL
Article, see p 1997
The fact that the concentration of low-density lipoprotein (LDL) cholesterol is a risk factor for atherosclerotic cardiovascular disease (ASCVD) is beyond dispute, with genetic studies indicating that this relationship is causal.1 Furthermore, there is compelling evidence that therapies that reduce the concentration of LDL cholesterol also reduce the risk of having an ASCVD event.2 This evidence is robust in both primary and secondary prevention, in men and women, in older and younger people, in people with and without diabetes mellitus, in people with and without hypertension, and in people with higher or lower levels of baseline LDL cholesterol—in fact, in all people (with the possible exception of those with end-stage renal disease) at risk of having an ASCVD event.
There is also evidence in people being treated with a statin that additional lowering of LDL cholesterol, whether by using a higher dose of the same statin,3 by using a more effective statin,4 or by adding a nonstatin LDL cholesterol–lowering agent,5,6 results in a further reduction in the risk of having an ASCVD event. Most of these more versus less LDL cholesterol–lowering studies have been conducted in white populations and have substantially impacted lipid management guidelines in such populations.
Until recently, however, there has been no evidence in Asian populations of the clinical benefits of using high versus low doses of a statin. This lack of evidence, combined with a concern of possible adverse effects of high doses of statins in Asians, has resulted in a reluctance to use high doses of statins, even in high-risk Asian people.
But there is now compelling evidence that the clinical benefit of using a high versus a …