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Making practical sense of clinical trial data in decreasing cardiovascular risk

  • William P Castelli
    Correspondence
    Address for reprints: William P. Castelli, MD, Framingham Wellness Program Cardiovascular Institute, 115 Lincoln Street, Framingham, Massachusetts 01702
    Affiliations
    Framingham Cardiovascular Institute, Framingham, Massachusetts, USA
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      Abstract

      Clinical studies now affirm what epidemiologic evidence has long suggested—that a broad range of patients can benefit from lipid reduction, including those without overt coronary artery disease and only moderate lipid elevations. Together, these studies suggest that current goals for cholesterol reduction may not be sufficiently stringent to slow the epidemic of heart disease in this country and that aggressive lipid lowering may be just what the doctor should order.
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      References

        • Kannel W.B.
        • Dawber T.R.
        • Friedman G.D.
        • Glennon W.E.
        • McNamara P.M.
        Risk factors in coronary heart disease: an evaluation of several serum lipids as predictors of coronary heart disease.
        Ann Intern Med. 1964; 61: 888-899
        • Castelli W.P.
        The new pathophysiology of coronary artery disease.
        Am J Cardiol. 1998; 82: 60T-65T
        • Verschuren W.M.
        • Jacobs D.R.
        • Bloemberg B.P.
        • Kromhout D.
        • Menotti A.
        • Aravanis C.
        • Blackburn H.
        • Buzina R.
        • Dontas A.S.
        • Fidanza F.
        Serum total cholesterol and long-term coronary heart disease mortality in different cultures.
        JAMA. 1995; 274: 131-136
        • Chen Z.
        • Peto R.
        • Collins R.
        • MacMahon S.
        • Lu J.
        • Li W.
        Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations.
        BMJ. 1991; 303: 276-282
        • Wakugami K.
        • Iseki K.
        • Kimura Y.
        • Okumura K.
        • Ikemiya Y.
        • Muratani H.
        • Fukiyama K.
        Relationship between serum cholesterol and the risk of acute myocardial infarction in a screened cohort in Okinawa, Japan.
        Jpn Circ J. 1998; 62: 7-14
        • Kannel W.B.
        Range of serum cholesterol values in the population developing coronary artery disease.
        Am J Cardiol. 1995; 76: 69C-77C
      1. Executive Summary of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).
        JAMA. 2001; 285: 2486-2497
        • Pedersen T.R.
        • Olsson A.G.
        • Faergeman O.
        • Kjekshus J.
        • Wedel H.
        • Berg K.
        • Wilhelmsen L.
        • Haghfelt T.
        • Thorgeirsson G.
        • Pyörälä K.
        • 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
        • Lipid Research Clinics Program
        The Lipid Research Clinics Coronary Primary Prevention Trial results, II.
        JAMA. 1984; 251: 365-374
        • Stampfer M.J.
        • Sacks F.M.
        • Salvini S.
        • Willett W.C.
        • Hennekens C.H.
        A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction.
        N Engl J Med. 1991; 325: 373-381
        • Scandinavian Simvastatin Survival Study Group
        Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease.
        Lancet. 1994; 344: 1383-1389
        • Shepherd J.
        • Cobbe S.M.
        • Ford I.
        • Isles C.G.
        • Lorimer A.R.
        • MacFarlane P.W.
        • McKillop J.H.
        • Packard C.J.
        Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia.
        N Engl J Med. 1995; 333: 1301-1307
        • 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
        • Sacks F.M.
        • Pfeffer M.A.
        • Moyé L.A.
        • Rouleau J.L.
        • Rutherford J.D.
        • Cole T.G.
        • Brown L.
        • Warnica J.W.
        • Arnold J.W.
        • Wun C.C.
        • Davis B.R.
        • Braunwald E.
        The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels.
        N Engl J Med. 1996; 335: 1001-1009
        • Sprecher D.L.
        Lipid-lowering therapy for average lipid levels.
        Cleve Clin J Med. 1997; 64: 129-131
        • Downs J.R.
        • Clearfield M.
        • Weis S.
        • Whitney E.
        • Shapiro D.R.
        • Beere P.A.
        • Langendorfer A.
        • Stein E.A.
        • Kruyer W.
        • Gotto Jr, A.M.
        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
        • Gotto A.M.
        • Whitney E.
        • Stein E.A.
        • Shapiro D.R.
        • Clearfield M.
        • Weis S.
        • Jou J.Y.
        • Langendorfer A.
        • Beere P.A.
        • Watson D.J.
        • Downs J.R.
        • de Cani J.S.
        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
        • Post Coronary Artery Bypass Graft Trial Investigators
        The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts.
        N Engl J Med. 1997; 336: 153-162
        • Campeau L.
        • Hunninghake D.B.
        • Knatterud G.L.
        • White C.W.
        • Domanski M.
        • Forman S.A.
        • Forrester J.S.
        • Geller N.L.
        • Gobel F.L.
        • Herd J.A.
        • Hoogwerf B.J.
        • Rosenberg Y.
        Aggressive cholesterol lowering delays saphenous vein graft atherosclerosis in women, the elderly, and patients with associated risk factors.
        Circulation. 1999; 99: 3241-3247
        • Pitt B.
        • Waters D.
        • Brown W.V.
        • van Boven A.J.
        • Schwartz L.
        • Title L.M.
        • Eisenberg D.
        • Shurzinske L.
        • McCormick L.S.
        Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease.
        N Engl J Med. 1999; 341: 70-76
        • Schwartz G.G.
        • Oliver M.F.
        • Ezekowitz M.D.
        • Ganz P.
        • Waters D.
        • Kane J.P.
        • Texter M.
        • Pressler M.L.
        • Black D.
        • Chaitman B.R.
        • Olsson A.G.
        Rationale and design of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study that evaluates atorvastatin in unstable angina pectoris and in non-Q-wave acute myocardial infarction.
        Am J Cardiol. 1998; 81: 578-581
        • Schwartz G.G.
        • Olsson A.G.
        • Ezekowitz M.D.
        • Ganz P.
        • Oliver M.F.
        • Waters D.
        • Zeiher A.
        • Chaitman B.R.
        • Leslie S.
        • Stern T.
        • Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators
        Effects of atorvastatin on early recurrent ischemic events in patients with acute coronary syndromes.
        JAMA. 2001; 285: 1711-1718
        • Andrews T.C.
        • Raby K.
        • Barry J.
        • Naimi C.L.
        • Allred E.
        • Ganz P.
        • Selwyn A.P.
        Effect of cholesterol reduction on myocardial ischemia in patients with coronary disease.
        Circulation. 1997; 95: 324-328
        • Brown B.G.
        • Zhao X.-Q.
        • Sacco D.E.
        • Albers J.J.
        Lipid lowering and plaque regression.
        Circulation. 1993; 87: 1781-1791
        • Laufs U.
        • La Fata V.
        • Plutzky J.
        • Liao J.K.
        Upregulation of endothelial nitric oxide synthase by HMG CoA reductase inhibitors.
        Circulation. 1998; 97: 1129-1135
        • Gould K.L.
        • Martucci J.P.
        • Goldberg D.I.
        • Hess M.J.
        • Edens R.P.
        • Latifi R.
        • Dudrick S.J.
        Short-term cholesterol lowering decreases size and severity of perfusion abnormalities by positron emission tomography after dipyridamole in patients with coronary artery disease.
        Circulation. 1994; 89: 1530-1538