Skip to main content
SpringerLink
Log in

Goals of statin therapy: Three viewpoints

  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

The “lipid hypothesis” is now universally recognized as a law. Few issues in medicine are as completely resolved as the question of whether reducing serum cholesterol increases longevity. However, there are a few questions that remain, and the most important uncertainty is to what extent cholesterol should be reduced. The medical community, in partnership with government and industry, has contributed many excellent trials demonstrating the effects in patients with elevated cholesterol (above the mean). Where should our goal of therapy be? Until data is available from several large, ongoing trials, we do not have a final answer. We asked three investigators, Drs. Gilbert Thompson, Christopher Packard, and Neil Stone, who have all been integrally involved in the accumulation of our present database, to argue three different possible answers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, endorsed by the British Diabetic Association: Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 1998, 80(suppl 2):S1-S29.

    Google Scholar 

  2. Wood R, De Backer G, Faergeman O, et al.: Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of European and other Societies on Coronary Prevention. Atherosclerosis 1998, 140:199–270.

    Article  PubMed  CAS  Google Scholar 

  3. The National Service Framework for Coronary Heart Disease: London, Department of Health, 2000.

  4. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001, 285:2486–2496.

  5. Thompson GR, Naoumova RP: Novel lipid-regulating drugs. Expert Opin Investig Drugs 2000, 9:2619–2628.

    Article  PubMed  CAS  Google Scholar 

  6. Thompson GR: What targets should lipid-modulating therapy achieve to optimise the prevention of coronary heart disease. Atherosclerosis 1997, 131:1–5.

    Article  PubMed  CAS  Google Scholar 

  7. LaRosa JC, He J, Vupputuri S: Effect of statins on risk of coronary disease: a meta-analysis of randomised controlled trials. JAMA 1999, 282:2340–2346.

    Article  PubMed  CAS  Google Scholar 

  8. The Lipid Research Clinics Coronary Primary Prevention Trial results: II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA 1984, 251:365–374.

    Article  Google Scholar 

  9. Sacks F, Peffer MA, Moye LA, Rouleau JL, Rutherford JD, for the Cholesterol and Recurrent Trial Investigators (CARE study): The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996, 335:1001–1009.

    Article  PubMed  CAS  Google Scholar 

  10. Ridker PM, Rifal N, Clearfield M, Downs JR, Weis SE, for the Air Force/Texas Coronary Atherosclerosis Prevention Study Investigators: Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med 2001, 344:1959–1965.

    Article  PubMed  CAS  Google Scholar 

  11. West of Scotland Coronary Prevention Study Group: Influence of pravastatin and plasma lipids in the West of Scotland Coronary Prevention Study (WOSCOPS). Circulation 1998, 97:1440–1445.

    Google Scholar 

  12. Gotto AM, Grundy SM: Lowering LDL cholesterol. Questions from recent meta-analyses and subset analyses of clinical trial data issues from the Interdisciplinary Council on Reducing the Risk for Coronary Heart Disease. Ninth Council Meeting. Circulation 1999, 99:E1-E7.

    PubMed  Google Scholar 

  13. Stamler J, Wentworth D, Neaton JD: Is the relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 1986, 256:2823–2828.

    Article  PubMed  CAS  Google Scholar 

  14. Kannel WB: The Framingham Study: its 50-year legacy and future promise. J Atheroscler Thromb 2000, 6:60–66.

    PubMed  CAS  Google Scholar 

  15. Cullen P, Assman G: Treatment goals for low-density lipoprotein cholesterol in the secondary prevention of coronary heart disease: absolute levels or extent of lowering? Am J Cardiol 1997, 80:1287–1294.

    Article  PubMed  CAS  Google Scholar 

  16. Assmann G, Schulte H, Funke H, von Eckardstein A: The emergence of triglycerides as a significant independent risk factor in coronary artery disease. Eur Heart J 1998, Suppl M:M8–14.

    Google Scholar 

  17. Sharrett AR, Ballantyne CM, Coady SA, et al.: Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein(a), apolipoproteins a-i and b, and hdl density subfractions: the Atherosclerosis Risk in Communities (ARIC) study. Circulation 2001, 104:1108–1113.

    PubMed  CAS  Google Scholar 

  18. Keys A, et al.: Seven countries: a multivariate analysis of death and coronary heart disease. Cambridge: Harvard University Press; 1980:1–381.

    Google Scholar 

  19. Goldstein JL, Hobbs HH, Brown MS: Familial hypercholesterolemia. In The Metabolic and Molecular Bases of Inherited Diseases. Edited by Scriver CR, Beaudet AL, Sly WS, Valle D. New York: McGraw Hill; 1985:1981–2030.

    Google Scholar 

  20. Shepherd J, Cobbe SM, Ford I, for the West of Scotland Coronary Prevention Study Group: Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995, 333:1301–1307.

    Article  PubMed  CAS  Google Scholar 

  21. Downs JR, Clearfield M, Whitney E, et al.: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. JAMA 1998, 279:1615–1622.

    Article  PubMed  CAS  Google Scholar 

  22. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994, 344:1383–1389.

  23. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group: Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998, 339:1349–1357.

    Article  Google Scholar 

  24. Gould AL, Rossouw JE, Santanello NC, Heyse JF, Furberg CD: Cholesterol reduction yields clinical benefit. Impact of statin trials. Circulation 1998, 97:946–952.

    PubMed  CAS  Google Scholar 

  25. Pedersen TR, Olsson AG, Faergeman O, et al.: Lipoprotein changes and reduction in the incidence of major coronary heart disease events in the Scandinavian Simvastatin Survival Study (4S). Circulation 1998, 97:1453–1460.

    PubMed  CAS  Google Scholar 

  26. Sacks FM, Moye LA, Davis BR, et al.: Relationship between plasma LDL concentrations during treatment with pravastatin and recurrent coronary events in the Cholesterol and Recurrent Events trial. Circulation 1998, 97:1446–1452.

    PubMed  CAS  Google Scholar 

  27. Sacks FM, Tonkin AM, Shepherd J, et al.: Effect of pravastatin on coronary disease events in subgroups defined by coronary risk factors. The Prospective Pravastatin Pooling Project. Circulation 2000, 102:1893–1900.

    PubMed  CAS  Google Scholar 

  28. Gotto AM, Witney E, Stein EA, et al.: Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TEXCAPS). Circulation 2000, 101:477–484.

    PubMed  CAS  Google Scholar 

  29. Grundy SM: Statin trials and goals of cholesterol-lowering therapy. Circulation 1998, 97:1436–1439.

    PubMed  CAS  Google Scholar 

  30. Knatterud GL, Rosenberg Y, Campeau L, et al.: Long-term effects on clinical outcomes of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation in the Post Coronary Artery Bypass Graft Trial. Circulation 2000, 102:157–165.

    PubMed  CAS  Google Scholar 

  31. MacMahon M, Kirkpatrick C, Cummings CE, et al.: A pilot study with simvastatin and folic acid/vitamin B12 in preparation for the Study of the Effectiveness of Additional Reductions in Cholesterol and Homocysteine (SEARCH). Nutr Metab Cardiovasc Dis 2000, 10:195–203.

    PubMed  CAS  Google Scholar 

  32. Abate N, Vega GL, Grundy SM: Variability in cholesterol content and physical properties of lipoproteins containing apolipoprotein B-100. Atherosclerosis 1993, 104:159–171.

    Article  PubMed  CAS  Google Scholar 

  33. Vega GL, Grundy SM: Does measurement of apolipoprotein B have a place in cholesterol management? Arteriosclerosis 1990, 10:668–671.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Metabolic Medicine, Imperial College School of Medicine, Hammersmith Hospital, Du Cane Road, W12 0NN, London, United Kingdom

    Gilbert R. Thompson MD

  2. Department of Pathological Biochemistry, Glasgow Royal Infirmary, 4th Floor, University Block, 10 Alexandra Parade, G31 2ER, Glasgow, United Kingdom

    Christopher J. Packard DSc, FRCPath

  3. Northwestern University School of Medicine, 211 E. Chicago Avenue, #1050, 60611, Chicago, IL, USA

    Neil J. Stone MD

Authors
  1. Gilbert R. Thompson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher J. Packard DSc, FRCPath
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Neil J. Stone MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thompson, G.R., Packard, C.J. & Stone, N.J. Goals of statin therapy: Three viewpoints. Curr Atheroscler Rep 4, 26–33 (2002). https://doi.org/10.1007/s11883-002-0059-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11883-002-0059-6

Keywords

Search

Navigation