There is a large consensus on the fact that the overall body of evidence shows a drop in LDL cholesterol (low density lipoprotein) offers statistically significant and clinically significant advantages in the treatment and prevention of cardiovascular disease. Often called “bad” cholesterol, high LDL levels can obstruct the arteries and considerably increase the risk of heart attacks and strokes.
In an invited editorial published in the current issue of Trends in Cardiovascular Medicine, researchers from the Schmidt College of Medicine of Florida Atlantic University urge cardiologists practicing the lower LDL cholesterol levels, starting with the highest doses of the most powerful statins, namely the rosuvastin and Atorvastatin. The authors emphasize that high -power statins should be the main pharmacological in the treatment of cardiovascular diseases as complements to changes in therapeutic lifestyle.
Researchers point out that changes in therapeutic lifestyle will be effective in the absence and presence of complementary therapies in the treatment and prevention of cardiovascular disease. The changes in lifestyle of proven advantages include avoidance or cessation of smoking, the realization and maintenance of a healthy body weight and blood pressure, regular physical activity and the restriction of alcohol consumption.
Despite the proven effectiveness of changes in therapeutic lifestyle, around 40% of adults in the United States suffer from metabolic syndrome, a constellation of risk factors, including obesity, hypertension, dyslipidemia and insulin resistance. These individuals have a cardiovascular risk equivalent to those with heart attacks or previous cerebral accidents, but many are sub-diagnosed and subcontracted.
The authors also point out that only around 21% of Americans meet the minimum daily requirements of physical activity, and that significant increases in physical activity are possible at any age, including in the elderly.
Based on the robust totality of randomized test data and their meta-analyzes, the authors conclude that statins-in particular rosuvastatin and atorvastatin-have the strongest and most coherent evidence corpus supporting their prescription for treatment and prevention in men and women, including older adults.
Since most patients tend to stay on their dose of statins initially prescribed, the authors recommend that cardiologists are planning to start therapy with the highest dose of these agents and to titrate them if necessary. They also point out that the advantages of statins and aspirin are at least additive and potentially synergistic. Most secondary prevention patients should be prescribed by aspirin. In primary prevention, however, individual clinical judgments are necessary and aspirin must be considered after statins-and if the residual risk of occlusion exceeds that of major bleeding, mainly gastrointestinal.
“Practitioner cardiologists may wish to consider that all drug therapy complementary to therapeutic lifestyle changes should only be added after reaching maximum doses of statins. In addition, statins have the greatest and most persuasive of evidence of any pharmacological disease for the treatment and prevention of cardiovascular disease, “said professor of Charles H. Hennenshens, MD, FACC, FACT of medicine and preventive medicine, and interim president, population of the population of the population, Schmidt College of Medicine.
Researchers offer cautious views of complementary therapies such as ezetimibe and evolocumab, which tend to be used more widely than optimal. For example, in the improve-it test, the addition of Ezetimibe to Simvastatin showed only a minor advantage, while the Fourier test has demonstrated the effectiveness of evolocumab in secondary prevention only in patients with family hypercholesterolemia already on maximum doses of statins. While Fourier was a completed secondary prevention test, Illuminat is an in progress in patients at high risk of primary prevention suffering from family hypercholesterolemia.
These results suggest that such therapies can be reserved more appropriately for certain high -risk patients who have not achieved LDL objectives with single statins. “”
Charles H. Hennekens, MD, FACC, senior author and correspondent
The authors also discuss the role of omega-3 fatty acids, noting that previous trials were positive but tended to show any clear advantage. The authors believe that this may be due to generalized use of statins. They note that in the reduction, a large-scale randomized trial, the icosapent ethyl was the only omega-3 fatty acid to demonstrate significant added advantages when added to doses based on proofs of high power statins. Patients assigned to chance at icosapent ethyl, a purified form of Eicosapentanoic acid, experienced a significant reduction of 25% of the main cardiovascular events, with a necessary number to treat only 21.
Hennekens also thought about the lasting relevance of the observation of Benjamin Franklin in 1736 according to which “an ounce of prevention is worth a healing book”.
The first author of the editorial is John Dunn, a third -year student in medicine at the Schmidt College of Medicine.
