Statins in primary prevention of cardiovascular disease
Statins are recognized to lower blood cholesterol levels, but there are people who put their problem in the administration of statins in order to prevent cardiovascular disease. Lately a number of meta-analyzes were conducted to evaluate the effectiveness of statins in primary prevention of heart disease. The need to use statins depends on one thing – the risk of myocardial infarction. How necessary are these drugs for people who want to prevent heart disease?
There is already no doubt about the administration of statins in patients with cardiovascular disease. In their case the treatment is effective, supported by strong evidence, according to the BMJ. Recent trials made with statins, which included data from 30,817 patients, have demonstrated an almost linear relationship between LDL cholesterol levels and coronary events.
Statins in primary prevention
More problematic is, however, prescribing these drugs for people with a decreased risk of cardiovascular disease, their situation is less clear. Following an overview of Cochrane, it has been highlighted several parameters in patients treated with statins: reduction in mortality from any cause, decreased to 28% of fatal coronary heart disease and non-fatal, decrease by 22% of stroke and non-fatal and lower revascularization rate for a period of 3-4 years by 34%. Although this synthesis did not reveal any adverse effect of statins and demonstrated their effectiveness in primary prevention, the researchers draw attention to some deficiencies: use of composite endpoints, failure to report adverse effects in some cases, and 13 of the 14 studies were funded by pharmaceuticals companies, according to a study.
On the other hand, data from the two trials Air Force / Texas Coronary Atherosclerosis Study (primary prevention) and Long-Term Intervention with Pravastatin in Ischemic Disease Study (secondary prevention) showed a number of benefits of statin therapy in reducing the risk of coronary in patients with average lipid levels.
The conclusion presented by the British Medical Journal is that “the administration of statins in people with a very low risk of cardiovascular disease is not necessary, being recommended according to the risk posed to the individual patient.”
To whom are recommended statins?
“What group of cardiovascular disease-free population is most suitable for initiating long-term treatment with statins?” Is the question raised by the British Medical Journal. Judging by the evidence, statins can be a good solution for patients with diabetes (men up to 50 years and women up to 60 years) for men over 55 who have multiple risk factors for women over 65 years.
Elderly are recommended relatively low doses of statins. Regarding hypertensive patients, they should receive appropriate therapy instituted because there is a strong correlation between heart failure, stroke and hypertension.
The ABCDE of cardiovascular prevention
Lowering blood cholesterol is only one component of cardiovascular disease prevention measures. According to BMJ, The ABCDE approaches to prevent heart disease include:
Evaluation of the risk in order to determine the eligibility of patients for initiating a therapeutic scheme of cholesterol-lowering agents and aspirin;
Control of blood pressure;
The Management of cholesterol and stop smoking;
A regular diet;