Status of Statins: Indications, Utilization, and Unanswered Questions
Status of Statins: Indications, Utilization, and Unanswered Questions
Several landmark trials have established statins as first-line lipid-lowering therapy for the secondary prevention of coronary artery disease (CAD). Recent evidence has supported their role in primary prevention of CAD as well. Their range of indications seems to be expanding, and patients with diabetes mellitus, acute coronary syndromes (ACS), and dyslipidemias associated with uremia may also benefit from statins. Emerging data suggest that the statins also possess immunosuppressive, antiproliferative, and blood pressure lowering effects. Despite overwhelming proof of efficacy and safety, statins seem to be underused, especially in the geriatric age group. Even after extensive use, statins have left some questions unanswered, like which of them is a better choice, up to what levels should low density lipoprotein cholesterol (LDL-C) be lowered, what is their effect on fibrinogen and apolipoprotein (B) levels, and what is their role in dyslipidemias associated with HIV infection. Although earlier concerns with regard to risk of cancer, cataracts, and CNS toxicity have not been substantiated, concerns have recently arisen with regard to risk of peripheral neuropathy.
Coronary artery disease (CAD) is a leading cause of morbidity and mortality in the developed, as well as developing, countries. It is well established that patients with dyslipidemias are at an increased risk of developing atherosclerosis and subsequent CAD. The availability of the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors ("statins") has revolutionized the treatment of lipid abnormalities. Not surprisingly, the decade of the 1990s has been termed the "statin decennial" in the history of CAD prevention. The developments in this field are taking place at a rapid rate, and it is difficult to keep pace with them. This review summarizes the current indications for statins, highlights their use patterns, and reflects on some issues that are not resolved.
Several landmark trials have established statins as first-line lipid-lowering therapy for the secondary prevention of coronary artery disease (CAD). Recent evidence has supported their role in primary prevention of CAD as well. Their range of indications seems to be expanding, and patients with diabetes mellitus, acute coronary syndromes (ACS), and dyslipidemias associated with uremia may also benefit from statins. Emerging data suggest that the statins also possess immunosuppressive, antiproliferative, and blood pressure lowering effects. Despite overwhelming proof of efficacy and safety, statins seem to be underused, especially in the geriatric age group. Even after extensive use, statins have left some questions unanswered, like which of them is a better choice, up to what levels should low density lipoprotein cholesterol (LDL-C) be lowered, what is their effect on fibrinogen and apolipoprotein (B) levels, and what is their role in dyslipidemias associated with HIV infection. Although earlier concerns with regard to risk of cancer, cataracts, and CNS toxicity have not been substantiated, concerns have recently arisen with regard to risk of peripheral neuropathy.
Coronary artery disease (CAD) is a leading cause of morbidity and mortality in the developed, as well as developing, countries. It is well established that patients with dyslipidemias are at an increased risk of developing atherosclerosis and subsequent CAD. The availability of the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors ("statins") has revolutionized the treatment of lipid abnormalities. Not surprisingly, the decade of the 1990s has been termed the "statin decennial" in the history of CAD prevention. The developments in this field are taking place at a rapid rate, and it is difficult to keep pace with them. This review summarizes the current indications for statins, highlights their use patterns, and reflects on some issues that are not resolved.
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