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Hmg Coa Reductase Inhibitors for Cardiovascular Risk Reduction

Hmg Coa Reductase Inhibitors for Cardiovascular Risk Reduction

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Statin drugs, ie, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, have become a cornerstone in the conventional management of dyslipidemia and cardiovascular disease. Enthusiasm for statin prescribing is weaker among integrative providers who prioritize lifestyle change and nonpharmaceutical lipid-lowering measures or who deny a contribution of low-density lipoproteins (LDL) to cardiovascular risk. However, numerous large, well-designed, rigorously scrutinized clinical trials have documented the benefits of statin medications in reducing major cardiovascular events, including myocardial infarction, stroke, and revascularization procedures, as well as cardiovascular and all-cause mortality. These benefits have been documented in both primary and secondary prevention and in both low-risk and high-risk patient populations including patients with and without diabetes. Additionally, the benefits of statins remain evident for elderly and female patients despite less robust evidence, while less convincing evidence is available in some disease subgroups including congestive heart failure and kidney disease requiring dialysis. Although LDL lowering appears to be the predominant mechanism of statin protection, statins also reduce vascular inflammation, improve endothelial function, and improve LDL size/density patterns. Although adverse effects of statin medications are possible and can be serious, the overall safety profile of statins remains very good. Patients seeking counsel on evidence-based treatments for lipid lowering and protection against cardiovascular disease events and death deserve honest, unbiased dialogue about whether they are good candidates for medications in this class.
Statin drugs, ie, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, have become a cornerstone in the conventional management of dyslipidemia and cardiovascular disease. Enthusiasm for statin prescribing is weaker among integrative providers who prioritize lifestyle change and nonpharmaceutical lipid-lowering measures or who deny a contribution of low-density lipoproteins (LDL) to cardiovascular risk. However, numerous large, well-designed, rigorously scrutinized clinical trials have documented the benefits of statin medications in reducing major cardiovascular events, including myocardial infarction, stroke, and revascularization procedures, as well as cardiovascular and all-cause mortality. These benefits have been documented in both primary and secondary prevention and in both low-risk and high-risk patient populations including patients with and without diabetes. Additionally, the benefits of statins remain evident for elderly and female patients despite less robust evidence, while less convincing evidence is available in some disease subgroups including congestive heart failure and kidney disease requiring dialysis. Although LDL lowering appears to be the predominant mechanism of statin protection, statins also reduce vascular inflammation, improve endothelial function, and improve LDL size/density patterns. Although adverse effects of statin medications are possible and can be serious, the overall safety profile of statins remains very good. Patients seeking counsel on evidence-based treatments for lipid lowering and protection against cardiovascular disease events and death deserve honest, unbiased dialogue about whether they are good candidates for medications in this class.

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Published by: InnoVision Health Media on Jan 25, 2012
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05/22/2012

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