Should patients with high cardiovascular risk and an LDL.C concentration below 70 mg/dl be treated with aggressive statin therapy?

Reference

• Lloyd‑Jones DM, Hong Y, Labarthe D et al. On behalf of the American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s Strategic Impact Goal Through 2020 and Beyond. Circulation 121, 586–613 (2010).
   Google Scholar
• Martin MJ, Browner WS, Hulley SB, Kuller LH, Wentworth D. Serum cholesterol, blood pressure, and mortality: implications from a cohort of 361 662 men. Lancet 328, 933–936 (1986).
   Google Scholar
• Khot UN, Khot MB, Bajzer CT et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 290, 898–904 (2003).
   Google Scholar
• Baigent C, Blackwell L, Emberson J et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta‑ana lysis of data from 170,000 participants in 26 randomised trials. Lancet 376, 1670–1681 (2010).
   Google Scholar
• Grundy SM, Cleeman JI, Merz CNB et al. For the Coordinating Committee of the National Cholesterol Education Program and endorsed by the National Heart, Lung, and Blood Institute, American College of Cardiology Foundation, and American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel 3 guidelines. Circulation 110, 227–239 (2004).
   Google Scholar
• Castelli WP. Lipids, risk factors and ischaemic heart disease. Atherosclerosis 124, S1–S9 (1996).
   Google Scholar
• Sachdeva A, Cannon CP, Deedwania PC et al. Lipid levels in patients hospitalized with coronary artery disease: an ana lysis of 136,905 hospitalizations in get with the guidelines. Am. Heart J. 157, 111–117 (2009).
   Google Scholar
• Ravnskov U. Cholesterol lowering trials in coronary heart disease: frequency of citation and outcome. BMJ 305, 15–19 (1992).
   Google Scholar
• Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 344, 1383–1389 (1994).
   Google Scholar
• Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high‑risk individuals: a randomised placebo‑controlled trial. Lancet 360, 7–22 (2002).
   Google Scholar
• Cholesterol Treatment Trialists‘ (CTT) Collaborators. Efficacy and safety of cholesterol‑lowering treatment: prospective meta‑ana lysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 366, 1267–1278 (2005).
   Google Scholar
• Pfeffer MA, Sacks FM, Moyé LA et al. Influence of baseline lipids on effectiveness of pravastatin in the CARE trial. Cholesterol and Recurrent Events. J. Am. Coll. Cardiol. 33, 125–130 (1999).
   Google Scholar
• Spencer FA, Goldberg RJ, Gore JM et al. Comparison of utilization of statin therapy at hospital discharge and six‑month outcomes in patients with an acute coronary syndrome and serum low‑density lipoprotein > or = 100 mg/ dl versus <100 mg/dl. Am. J. Cardiol. 100, 913–918 (2007).
   Google Scholar
• Schwartz GG, Olsson AG, Ezekowitz MD et al. Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 285, 1711–1718 (2001).
   Google Scholar
• Leeper NJ, Ardehali R, deGoma EM, Heidenreich PA. Statin use in patients with extremely low low‑density lipoprotein levels is associated with improved survival. Circulation 116, 613–618 (2007).
   Google Scholar
• Lee KH, Jeong MH, Kim HM et al. KAMIR (Korea Acute Myocardial Infarction Registry) Investigators. Benefit of early statin therapy in patients with acute myocardial infarction who have extremely low lowdensity lipoprotein cholesterol. J. Am. Coll. Cardiol. 58, 1664–1671 (2011).
   Google Scholar
• Giraldez RR, Giugliano RP, Mohanavelu S et al. Baseline low‑density lipoprotein cholesterol is an important predictor of the benefit of intensive lipid‑lowering therapy: a PROVE IT‑TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis in Myocardial Infarction 22) analysis. J. Am. Coll. Cardiol. 52, 914–920 (2008).
   Google Scholar
• Wiviott SD, Cannon CP, Morrow DA et al.; PROVE IT‑TIMI 22 Investigators. Can low‑density lipoprotein be too low? The safety and efficacy of achieving very low low‑density lipoprotein with intensive statin therapy: a PROVE IT‑TIMI 22 substudy. J. Am. Coll. Cardiol. 46, 1411–1416 (2005).
   Google Scholar
• Wiviott SD, Mohanavelu S, Raichlen JS, Cain VA, Nissen SE, Libby P. Safety and efficacy of achieving very low low‑density lipoprotein cholesterol levels with rosuvastatin 40 mg daily (from the ASTEROID study). Am. J. Cardiol. 104, 29–35 (2009).
   Google Scholar
• Glueck CJ, Kelley W, Gupta A, Fontaine RN, Wang P, Gartside PS. Prospective 10‑year evaluation of hypobetalipoproteinemia in a cohort of 772 firefighters and cross‑sectional evaluation of hypocholesterolemia in 1,479 men in the National Health and Nutrition Examination Survey I. Metabolism 46, 625–633 (1997).
   Google Scholar