Lipid Treatment for Cardiovascular Disease Prevention

Approximately 37% of adult Americans have cardiovascular disease (CVD), and the prevalence of CVD risk factors such as obesity and dyslipidemia is growing.¹ In 2006, one-third of adults in the United States had elevated lowdensity lipoprotein cholesterol (LDL-C), and two-thirds were overweight or obese.¹

The guidelines of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, Adult Treatment Panel III (ATP III; originally published in 20012 and updated in 20043) emphasize achieving optimal LDL-C levels as pivotal for reducing the risk of cardiovascular events in persons with or without established coronary heart disease (CHD). The guidelines provide a validated scoring system for determining a person’s cardiovascular risk and setting specific LDL-C goals based on risk category. The updated guidelines recommend an LDL-C level of < 100 mg/dL for all high-risk patients (ie, with CHD or a CHD risk equivalent such as diabetes) and an LDL-C level of < 70 mg/dL as a therapeutic option for patients at very high risk, including those with acute coronary syndromes and those with metabolic syndrome.³

Although therapeutic lifestyle changes can improve most modifiable risk factors, many patients with dyslipidemia will not achieve recommended lipid goals without pharmacotherapy. Statins remain the therapy of choice for safe and effective lipid management. Recent outcomes studies comparing the intensity of statin therapy necessary to provide incremental benefit suggest that some patients may receive additional benefit by exceeding recommended treatment goals.^4-6 The results of the JUPITER study showed that an on-treatment LDL-C level of < 70 mg/dL may be an appropriate goal for some high-risk persons.⁷ Fibrates, niacin, or omega-fatty acids may improve the control of high-density lipoprotein cholesterol and triglycerides in patients with mixed dyslipidemia^8-10; however, the cardiovascular benefits of adding these drugs to statin therapy have not been demonstrated yet.

The first of 2 articles in this supplement focuses on the need to determine a patient's CVD risk as a precondition for appropriate risk reduction strategies and examines various therapeutic options for individualized care. The second article discusses the central role of statins in attaining recommended therapeutic lipid goals in light of recent outcomes studies.

References:

REFERENCES:

1. American Heart Association. Heart Disease and Stroke Statistics-2010 Update.Dallas, TX: American Heart Association; 2010.
2. Executive Summary of The Third Report of The National CholesterolEducation Program (NCEP) Expert Panel on Detection, Evaluation, and Treatmentof High Blood Cholesterol in Adults (Adult Treatment Panel III).

JAMA

.2001;285:2486-2497.
3. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trialsfor the National Cholesterol Education Program Adult Treatment Panel IIIguidelines.

Circulation

. 2004;110:227-239.
4. de Lemos JA, Blazing MA, Wiviott SD, et al. Early intensive vs a delayedconservative simvastatin strategy in patients with acute coronary syndromes:phase Z of the A to Z trial.

JAMA

. 2004;292:1307-1316.
5. LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering withatorvastatin in patients with stable coronary disease.

N Engl J Med

. 2005;352:1425-1435.
6. Pedersen TR, Faergeman O, Kastelein JJ, et al. High-dose atorvastatin vsusual-dose simvastatin for secondary prevention after myocardial infarction: theIDEAL study: a randomized controlled trial. JAMA. 2005;294:2437-2445.7. Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascularevents in men and women with elevated C-reactive protein.

N Engl J Med

.2008;359:2195-2207.
8. Ginsberg HN, Elam MB, Lovato LC, et al. Effects of combination lipid therapyin type 2 diabetes mellitus. N Engl J Med. 2010;362:1563-1574.9. Goldberg A, Alagona P Jr, Capuzzi DM, et al. Multiple-dose efficacy and safetyof an extended-release form of niacin in the management of hyperlipidemia.

Am J Cardiol

. 2000;85:1100-1105.
10. Goldberg RB, Sabharwal AK. Fish oil in the treatment of dyslipidemia.

Curr Opin Endocrinol Diabetes Obes

. 2008;15:167-174.

Support
Jinling Wu, PhD, Roland Tacke, PhD, and Marsha Hall,Scientific Connexions, Newtown, Pennsylvania, providedmedical writing support, and Maria D’Alessandro and ColleenHedge, Scientific Connexions, provided editorial assistance.Writing support and editorial assistance were funded byAstraZeneca LP, Wilmington, Delaware.

Disclosures
Peter H. Jones, MDConsultant: Abbott Laboratories, AstraZeneca, Atherotec,Merck & Co., Roche/Genentech
Speaker: Abbott Laboratories, AstraZeneca, Merck & Co.,Daiichi Sankyo