Reducing Residual Risk in Secondary Prevention of CVD
Prevention of cardiovascular disease (CVD) spans the human lifespan including primordial, primary and secondary prevention efforts. Extensive evidence from epidemiologic, genetic, and animal studies confirm the central importance of elevated LDL-C in atherosclerotic CVD events1. The Cholesterol Treatment Trialists Collaboration provides per-person documentation from large-scale randomized clinical trials (RCTs) of the striking reduction in CVD events per mmol (38.8 mg/dl) of LDL-C lowering with statins over a wide range of baseline LDL-C values2,3. It's worth recalling that the major statin trials were not designed to determine the effectiveness of titration to LDL-C or even to non HDL-C goals by statins, but were fixed dose comparisons of various statins against placebo and then more recently large dose statin therapy versus moderate dose statin therapy. What is not so clear is whether we can intervene to reduce so-called "residual" risk further in secondary prevention patients optimally treated with statin therapy. A promising short list of proposed potential targets other than LDL includes efforts to promote smoking cessation and therapies to improve the pro-thrombotic and inflammatory state of the metabolic syndrome and to control elevated blood pressure4. (SELECT FULL TEXT TO CONTINUE)
- Received March 20, 2012.
- Accepted March 20, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited