Current Atherosclerosis Reports

, Volume 8, Issue 5, pp 390–396 | Cite as

Statins and the primary prevention of cardiovascular events



Cardiovascular disease remains the leading cause of death in both men and women in the United States. Treating elevated low-density lipoprotein (LDL) cholesterol has been shown to be very effective in reducing the rate of coronary heart disease (CHD) in primary prevention trials; however, the data are not as robust for treating individuals categorized at either lower risk for CHD or with below-average LDL cholesterol levels. The next frontier for investigation will include strategies to determine who in these lower risk categories should be treated with statins. The growing epidemics of obesity, diabetes, and metabolic syndrome also loom as major problems that need to be incorporated into any strategy that focuses on the prevention of cardiovascular disease. In individuals with multiple cardiovascular risk factors, combination therapies tailored to address each individual’s risk profile need to be considered to best decrease the likelihood of their first coronary event.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Murray CJ, Lopez AD, (eds.): The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Boston: Harvard School of Public Health; 1996.Google Scholar
  2. 2.
    Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the National Cholesterol Education Program (NCEP) (Adult Treatment Panel III). JAMA 2001, 285:2486–2497.CrossRefGoogle Scholar
  3. 3.
    Grundy SM, Cleeman JI, Bairey CN, et al.: Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004, 110:227–229.PubMedCrossRefGoogle Scholar
  4. 4.
    Shepherd J, Cobbe SM, Ford I, et al., 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.PubMedCrossRefGoogle Scholar
  5. 5.
    Downs JR, Clearfield M, Weis S, et al., for the AFCAPS/TexCAPS Research Group: Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels. JAMA 1998, 279:1615–1622.PubMedCrossRefGoogle Scholar
  6. 6.
    Heart Protection Study Collaborative Group: MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high risk individuals: a randomized placebo controlled trial. Lancet 2002, 360:7–22.CrossRefGoogle Scholar
  7. 7.
    Prosper Study Group: Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a ramdomized placebo-controlled trial. Lancet 2002, 360:1623–1630.CrossRefGoogle Scholar
  8. 8.
    The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care. JAMA 2002, 288:2998–3007.CrossRefGoogle Scholar
  9. 9.
    Sever PS, Dalhof B, Poulter NR, et al.: Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower than average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003, 361:1149–1158.PubMedCrossRefGoogle Scholar
  10. 10.
    Colhoun HM, Betteridge DJ, Durrington PN, et al.: Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): a multicentre randomized placebo-controlled trial. Lancet 2004, 364:685–696.PubMedCrossRefGoogle Scholar
  11. 11.
    Cholesterol Treatment Trialists Collaborators: Efficacy and safety of cholesterol lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005, 366:1267–1278.CrossRefGoogle Scholar
  12. 12.
    Clearfield M, Downs JR, Lee M, et al.: Implications from the Air Force/Texas Coronary Atherosclerosis Prevention Study for the Adult Treatment Panel III Guidelines. Am J Cardiol 2005, 96:1674–1680.PubMedCrossRefGoogle Scholar
  13. 13.
    O’Keefe HH, Cordain L, Harris WH, et al.: Optimal low density lipoprotein is 50 to 70 mg/dl. J Am Coll Cardiol 2004, 43:2142–2146.PubMedCrossRefGoogle Scholar
  14. 14.
    Ridker PM: Rosuvastatin in primary prevention of cardiovascular disease among patients with low levels of low-density lipoprotein cholesterol and elevated high sensitivity c-reactive protein: rationale and design of the JUPITER Trial. Circulation 2003, 108:2292–2297.PubMedCrossRefGoogle Scholar
  15. 15.
    Ridker PM, Rifai N, Clearfield M, et al.: Measurement of C-Reactive protein for targeting of statin therapy in the primary prevention of acute coronary events. Air Force/Texas Coronary Atherosclerosis Prevention Study Investigators. N Engl J Med 2001, 344:1959–1965.PubMedCrossRefGoogle Scholar
  16. 16.
    Ford ES: Risks for all cause mortality, cardiovascular disease and diabetes associated with the metabolic syndrome. Diabetes Care 2005, 28:1769–1778.PubMedCrossRefGoogle Scholar
  17. 17.
    Girman CJ, Rhodes T, Mercuri M, et al.: The metabolic syndrome and risk of major coronary events in the 4S and AFCAPS/TexCAPS study. Am J Cardiol 2004, 93:136–141.PubMedCrossRefGoogle Scholar
  18. 18.
    Sattar N, Gaw A, Scherbakova O, et al.: Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 2003, 108:414–419.PubMedCrossRefGoogle Scholar
  19. 19.
    Eberly LE, Prineas R, Cohen JD, et al.: Metabolic syndrome; risk factor distribution and 19 year mortality in the Multiple Risk Factor Intervention Trial. Diabetes Care 2006, 29:123–130.PubMedCrossRefGoogle Scholar
  20. 20.
    Lloyd-Jones DM, Nam BH, D’Agostino RB, et al.: Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults. JAMA 2004, 292:2204–2211.CrossRefGoogle Scholar
  21. 21.
    Reinhard W, Holmer SR, Fischer M, et al.: Association of the metabolic syndrome with early coronary disease in families with frequent myocardial infarction. Am J Cardiol 2006, 97:964–967.PubMedCrossRefGoogle Scholar
  22. 22.
    Ridker PM, Buring JE, Cook NR, et al.: C-reactive protein, the metabolic syndrome and risk incident cardiovascular events. Circulation 2003, 107:391–397.PubMedCrossRefGoogle Scholar
  23. 23.
    Malik S, Wong ND, Franklin S, et al.: Cardiovascular disease in U.S. patients with metabolic syndrome, diabetes and elevated C-reactive protein. Diabetes Care 2005, 28:690–693.PubMedCrossRefGoogle Scholar
  24. 24.
    Ridker PM, Wilson PW, Grundy SM: Should C-reactive protein be added to metabolic syndrome and to assessment of global cardiovascular risk? Circulation 2004, 109:282–2825.Google Scholar
  25. 25.
    Sdringola S, Nakagawa K, Nakagawa Y, et al.: Combined intense lifestyle and pharmacologic lipid treatment further reduce coronary events and myocardial perfusion abnormalities compared with usual care cholesterol lowering drugs in coronary artery disease. J Am Coll Cardiol 2003, 41:263–272.PubMedCrossRefGoogle Scholar
  26. 26.
    Muhlstein JB: Post-hospiralization management of high risk coronary patients. Am J Cardiol 2000, 85:13B-20B.CrossRefGoogle Scholar
  27. 27.
    Mukherjee D, Fang J, Chetcuti S, et al.: Impact of combination evidence-based medical therapy in patients with acute coronary syndrome Circulation 2004, 109:745–749.28.PubMedCrossRefGoogle Scholar
  28. 28.
    Hennekens CH, Sacks FM, Tonkin A, et al.: Additive benefits of pravastati and aspirin to decrease risks of cardivascular disease. Arch Intern Med 2004, 164:40–44.PubMedCrossRefGoogle Scholar
  29. 29.
    Brown G, Albers JJ, Fisher LD, et al.: Regression of coronary artery disease as a result of intensive lipid lowering in men with high levels of apolipoprotein B. N Engl J Med 1990, 323:1289–1298.PubMedCrossRefGoogle Scholar
  30. 30.
    Brown G, Zhao XQ, Chait A, et al.: Simvastatin and niacin, antioxidant vitamins or the combination for the prevention of coronary disease. N Engl J Med 2001, 345:1583–1592.PubMedCrossRefGoogle Scholar
  31. 31.
    Grover SA, Pacquet S, Levinton C, et al.: Estimating the benefits of modifying risk factors of cardiovascular disease. Arch Intern Med 1998, 158:655–662.PubMedCrossRefGoogle Scholar
  32. 32.
    Go AS, Iribarren C, Chandra M, et al.: Statin and B-blocker therapy and the initial presentation of coronary heart disease. Ann Intern Med 2006, 144:229–238.PubMedGoogle Scholar
  33. 33.
    Gaede P, Vedel P, Larsen N, et al.: Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003, 348:383–393.PubMedCrossRefGoogle Scholar
  34. 34.
    Gaede P: Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomized study. Lancet 1999, 353:617–622.PubMedCrossRefGoogle Scholar
  35. 35.
    Wong ND, Pio JR, Franklin SS, et al.: Preventing coronary events by optimal control of blood pressure, and lipids in patients with the metabolic syndrome. Am J Cardiol 2003, 91:1421–1426.PubMedCrossRefGoogle Scholar
  36. 36.
    Wald NJ, Law MR: A stategy to reduce cardiovascular disease by more than 80%. BMJ 2003, 28:1419–1423.CrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.University of North Texas Health Science CenterFort WorthUSA

Personalised recommendations