50% lowering of LDL-C from the baseline value. Half of all patients and 53% of women with CHD failed to achieve the target >50% reduction in LDL-C. There is a major lack of family “cascade” testing. Funding for DNA testing and cascade testing is lacking in many parts of the UK.
The benefit of treatment with HMG-CoA reductase inhibitors (statins) is unquestioned, with multiple studies over the last 20 years having shown that statins improve cardiovascular (CV) outcomes.1 Although all statins reduce low-density lipoprotein cholesterol (LDL-C), their potencies differ. The decreasing order of potency (per milligram) for LDL-C reduction is: rosuvastatin, atorvastatin, simvastatin and pravastatin.
Introduction: Clinical guidelines specifying target cholesterol levels may require dose titration strategies for patients who do not reach target. We describe a model that simulates cholesterol and cardiovascular risk reductions for different populations, therapies, titration steps and targets.
It is unsurprising that statins have become the most commonly prescribed drugs in many parts of the world, given the extraordinarily large and complete evidence base that supports their use. Their role in reducing cardiovascular (CV) events in both primary and secondary prevention is clear and predictable, with recent data extending their utility across most […]
What is the clinical trial evidence for the benefits of long-term statin therapy?Alan Begg
Structured monitoring of patients with long-term conditions has become a major component of scheduled care and a GP’s workload. The length of time a patient should remain on a certain medication to prevent a further cardiovascular event is often controversial, and phrasing recommendations to reflect the often absent evidence base is a problem for guideline writers. Recommendations on length of treatment are often informed by the results of randomised trials carried out for a limited period of time rather than reflecting long-term use in a defined patient cohort. This review reflects on the clinical trial evidence for long-term statin treatment in both primary and secondary prevention.
: Previous research has shown that routine monitoring appears to add little to the prognostication of incipient statininduced myotoxicity (SIM) in the primary care setting. In view of this, and the fact that there are now millions of patients on statins, it seems of practical value to delve deeper into the symptomatology of SIM. : To estimate the prevalence of SIM in statin users as compared to non-users, and whether family practice is the ideal setting to identify SIM.