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Systematic review on evidence of the effectiveness of cholesterol-lowering drugs

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Abstract

Introduction

Coronary heart disease (CHD) is the leading cause of mortality worldwide. With increasingly urbanized lifestyles in developing countries and the aging populations, the major risk factors for CHD such as obesity, diabetes mellitus, and hypercholesterolemia are likely to increase in the future. In the current report, we reviewed the evidence on the effect of cholesterol lowering using pharmacological agents.

Methods

A PubMed/Medline systematic search was performed over the past 12 years (1998–2009 inclusive) and relevant papers written in the English language were selected. We used key phrases including, “risk factors for hypercholesterolemia,” “management of hypercholesterolemia,” “guidelines for management of hypercholesterolemia,” and “pharmacological management of hypercholesterolemia.”

Results

There were a total of over 3500 reports. We selected key publications on the effect of cholesterol lowering using different pharmacological agents.

Conclusion

Several options exist with regards to pharmacological management of hypercholesterolemia. There is a substantial body of evidence to support the effect of a population shift towards a favorable risk profile, which has huge potential in reducing the burden of CHD globally.

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References

  1. DOH web site. Coronary heart disease. Policy and guidance. London: Department of Health. Available at: http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/CoronaryHeartDisease/fs/en. Last accessed February 24, 2010.

  2. Lloyd-Jones DM, Larson MG, Beiser A, et al. Lifetime risk of developing coronary heart disease. Lancet. 1999;353:89–92.

    Article  CAS  PubMed  Google Scholar 

  3. Verschuren WMM, Jacobs DR, Bloemberg BPM, et al. Serum total cholesterol and long term coronary heart disease mortality in different cultures: twenty five year follow up of the Seven Country Study. JAMA. 1995;274:131–136.

    Article  CAS  PubMed  Google Scholar 

  4. American Heart Association, National Heart, Lung, and Blood Institute. The cholesterol facts: a summary of the evidence relating dietary fats, serum cholesterol, and coronary heart disease. Circulation. 1990;81:1721–1733.

    Google Scholar 

  5. Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ. 1994;308:367–372.

    CAS  PubMed  Google Scholar 

  6. 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;285:2486–2497.

    Google Scholar 

  7. Wood D. Joint British Societies guidelines on prevention of cardiovascular disease in clinical practice. JBS-2. Heart. 2005;91(suppl. V):1–2.

    Google Scholar 

  8. Brown MS, Faust JR, Goldstein JL. Inhibition of 3-hydroxy 3-methylglutaryl coenzyme A reductase activity in human fibroblasts incubated with compactin (ML-236B), a competitive inhibitor of the reductase. J Biol Chem. 1978;253:1121–1128.

    CAS  PubMed  Google Scholar 

  9. Brown MS, Goldstein GL. A receptor mediated pathway for cholesterol homeostasis. Science. 1986;232:34–47.

    Article  CAS  PubMed  Google Scholar 

  10. Berglund LF, Beltz WF, Elam RL, Witztum JL. Altered apolipoprotein B metabolism in very low density lipoprotein from lovastatin-treated guinea pigs. J Lipid Res.1994;35:956–965.

    CAS  PubMed  Google Scholar 

  11. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease and stroke: systematic review and meta-analysis. BMJ. 2003;326:1423.

    Article  CAS  PubMed  Google Scholar 

  12. Chong PH, Kezele R, Franklin C. High-density lipoprotein cholesterol and the role of statins. Circ J. 2002;66:1037–1044.

    Article  CAS  PubMed  Google Scholar 

  13. 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 

  14. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Society of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7–22.

    Article  Google Scholar 

  15. La Rosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005;352:1425–1435.

    Article  Google Scholar 

  16. Nissen S, Nicholls S, Siphai I, et al. Effect of very high intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA. 2006;295:1556–1565.

    Article  CAS  PubMed  Google Scholar 

  17. Takemoto M, Liao JK. Pleotropic effects of 3 hydroxy 3 methylglutaryl coenzyme A reductase inhibitors. Arterioscler Thromb Vas Biol. 2001;21:1712.

    Article  CAS  Google Scholar 

  18. Gylling H, Miettinen TA. Baseline intestinal absorption and synthesis of cholesterol regulate its response to hypolipidaemic treatments in coronary patients. Atherosclerosis. 2002;160:477–478.

    Article  CAS  PubMed  Google Scholar 

  19. Olsson AG, Eriksson M, Johnson O, et al. A 52-week, multicenter, randomized, parallel-group, double-blind, double-dummy study to assess the efficacy of atorvastatin and simvastatin in reaching low-density lipoprotein cholesterol and triglyceride targets: the treat-to-target (3T) study. Clin Ther. 2003;25:119–138.

    Article  CAS  PubMed  Google Scholar 

  20. Jones PH, Davidson MH, Stein EA, et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR* Trial). Am J Cardiol. 2003;92:152–160.

    Article  CAS  PubMed  Google Scholar 

  21. Jones P, Kafonek S, Laurora I, Hunninghake D. Comparative dose efficacy study of atorvastatin vs simvastatin, pravastatin, lovastatin and fluvastatin in patients with hypercholesterolemia — the CURVES study. Am J Cardiol. 1998;81:582–587.

    Article  CAS  PubMed  Google Scholar 

  22. Silva MA, Swanson AC, Gandhi PJ, Tataronis GR. Statin related adverse events: a meta-analysis. Clin Ther. 2006;28:26–35.

    Article  CAS  PubMed  Google Scholar 

  23. Link E, Parish S, Armitage J, et al. SLCO1B1 variants and statin induced myopathy — a genomewide study. N Engl J Med. 2008;8:789–799.

    Google Scholar 

  24. Kane GC, Lipsky JJ. Drug grapefruit juice interactions. Mayo Clin Proc. 2000;75:933–942.

    Article  CAS  PubMed  Google Scholar 

  25. De Lemos JA, Blazing MA, Wiviott SD, et al. Early intensive vs a delayed conservative Simvastatin strategy in patients with acute coronary syndromes. Phase Z of the A to Z Trial. JAMA. 2004;292:1307–1316.

    Article  PubMed  Google Scholar 

  26. Graham DJ, Staffa JA, Shatin D, et al. Incidence of hospitalised rhabdomyolysis in patients treated with lipid lowering drugs. JAMA. 2004;292:2585–2590.

    Article  CAS  PubMed  Google Scholar 

  27. Dale KM, Coleman CI, Henyan NN, et al. Statins and cancer risk: a meta-analysis. JAMA. 2006;295:74–80.

    Article  CAS  PubMed  Google Scholar 

  28. Alsheikh-Ali AA, Maddukuri PV, Han H, Karas RH. Effect of magnitude of lipid lowering on risk of elevated liver enzymes, rhabdomyolysis and cancer: insights from large randomised statin trials. J Am Coll Cardiol. 2007;50:409–418.

    Article  CAS  PubMed  Google Scholar 

  29. Einarsson K, Ericsson S, Ewerth S, et al. Bile acid sequestrants: mechanisms of action on bile acid and cholesterol metabolism. Eur J Clin Pharmacol. 1991;40(suppl. 1):S53–S58.

    Article  PubMed  Google Scholar 

  30. Knopp RH. Drug treatment of lipid disorders. N Engl J Med. 1999;341:498–511.

    Article  CAS  PubMed  Google Scholar 

  31. Manninen V, Elo MO, Frick MH, et al. Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study. JAMA. 1988;260:641–651.

    Article  CAS  PubMed  Google Scholar 

  32. Rubins, Bloomfield H, Davenport J, et al. Reduction in stroke with gemfibrozil in men with coronary heart disease and low HDL cholesterol. The Veterans Affairs HDL Intervention Trial (VA-HIT). Circulation. 2001;103:2828–2833.

    CAS  Google Scholar 

  33. [No authors listed]. Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease: the BIP study. Circulation. 2000;102:21–27.

    Google Scholar 

  34. Vakkilainen J, Steiner G, Ansquer JC, et al. Relationships between LDL particle size, plasma lipoproteins and progression of coronary artery disease: the Diabetes Atherosclerosis Intervention Study (DIAS). Circulation. 2003;107:1733–1737.

    Article  PubMed  Google Scholar 

  35. FIELD Study Investigators. Effects of longterm fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study) randomised controlled trial. Lancet. 2005;366:1849–1861.

    Article  CAS  Google Scholar 

  36. Kind AH, Zakowski LJ, McBride PE. Rhabdomyolysis from the combination of a statin and gemfibrozil: an uncommon but serious adverse reaction. WMJ. 2002;101:53–56.

    PubMed  Google Scholar 

  37. McKenney JM, Proctor JD, Harris S, Chinchili VM. A comparison of the efficacy and toxic effects of sustained vs. immediate-release niacin in hypercholesterolemic patients. JAMA. 1994;271:672–677.

    Article  CAS  Google Scholar 

  38. Rosenson RS. Antiatherothrombotic effects of nicotinic acid. Atherosclerosis. 2003;171:87–96.

    Article  CAS  PubMed  Google Scholar 

  39. Canner PL, Berge KG, Wenger N, et al. Fifteen year mortality in Coronary Drug Project patients: long term benefit with niacin. J Am Coll Cardiol. 1986;8:1245–1255.

    Article  CAS  PubMed  Google Scholar 

  40. Brown G, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid lowering therapy in men with high levels of apolipoprotein B. N Engl J Med. 1990;323:1289–1298.

    CAS  PubMed  Google Scholar 

  41. Grundy SM, Vega GI, McGovern MI, et al. Efficacy, safety and tolerability of once-daily niacin for the treatment of dyslipidemia associated with type 2 diabetes. Arch Intern Med. 2002;162:1568–1576.

    Article  CAS  PubMed  Google Scholar 

  42. Temel RE, Tang W, Ma Y, et al. Hepatic Niemann-Pick C1 like 1 regulates biliary cholesterol concentration and is target of ezetimibe. J Clin Invest. 2007;117:1968–1978.

    Article  CAS  PubMed  Google Scholar 

  43. Knopp RH, Gitter H, Truitt T, et al. Ezetimibe Study Group. Effects of ezetimibe, a new cholesterol absorption inhibitor, on plasma lipids in patients with primary hypercholesterolemia. Eur Heart J. 2003;24:729–741.

    Article  CAS  PubMed  Google Scholar 

  44. Dujovne CA, Ettinger MP, McNeer JF, et al. Efficacy and safety of potent new selective cholesterol absorption inhibitor, ezetimibe in patients with primary hypercholesterolemia. Am J Cardiol. 2002;90:1092–1097.

    Article  CAS  PubMed  Google Scholar 

  45. Thomsen AB, Hasen HB, Christiansen C, Green H, Berger A. Effect of free plant sterols in low-fat milk on serum lipid profile in hypercholesterolemic subjects. Eur J Clin Nutr. 2004;58:860–870.

    Article  CAS  PubMed  Google Scholar 

  46. Patch CS, Tapsell LC, Williams PG. Plant sterol/stanol prescription is an effective treatment strategy for managing hypercholesterolemia in outpatient clinical practice. J Am Diet Assoc. 2005;105:46–52.

    Article  PubMed  Google Scholar 

  47. Plat J, Mensink RP. Plant stanol and sterol esters in the control of blood cholesterol levels: mechanism and safety aspects. Am J Cardiol. 2005;96:15–22.

    Article  CAS  Google Scholar 

  48. Kreisberg RA, Oberman A. Medical management of hyperlipidemia/dyslipidemia. J Clin Endocrinol Metab. 2003;88:2445–2461.

    Article  CAS  PubMed  Google Scholar 

  49. Yashodhra BM, Umakanth S, Pappachan JH. Omega 3 fatty acids: a comprehensive review of their role in health and disease. Postgrad Med J. 2009;85:84–90.

    Article  CAS  Google Scholar 

  50. Hu BF, Brouner L, Willet W. Fish and omega 3 fatty acids intake and risk of coronary heart disease in women. JAMA. 2002;287:1815–1821.

    Article  CAS  PubMed  Google Scholar 

  51. Albert C, Hennekem CH, O’Donnell C, et al. Fish consumption and risk of sudden cardiac death. JAMA. 1998;279:23–28.

    Article  CAS  PubMed  Google Scholar 

  52. Marchioli R, Barzi F, Bomba E, et al. GISSI Prevenzione Investigators. Early protection against sudden death by polyunsaturated fatty acids after myocardial infarction. Circulation. 2002;105:1897–1903.

    Article  CAS  PubMed  Google Scholar 

  53. Yokoyama H, Origasa H, Matsuzaki M, et al. JELIS Investigators. Effects of EPA on major coronary events in hypercholesterolemic patients. Lancet. 2007;369:1090–1098.

    Article  CAS  PubMed  Google Scholar 

  54. Hooper L, Thompson RL, Harrison RA, et al. Risks and benefits of O3FA for mortality, cardiovascular disease and cancer: systematic review. BMJ. 2006;333:752–760.

    Article  CAS  Google Scholar 

  55. Hooper L, Thompson RL, Harrison RA, et al.Omega 3 fatty acids for prevention and treatment of CVD. Cochrane Database Syst Rev. 2004;(4):CD003177.

  56. Mozaffarian D, Rimm EB. Fish intake, contaminants and human health: evaluating risks and benefits. JAMA. 2006;296:1885–1899.

    Article  CAS  PubMed  Google Scholar 

  57. Gapinski JP, Van Ruiswyk JV, Hendebert GR, et al. Preventing restenosis with fish oils following coronary angioplasty. A meta-analysis. Arch Intern Med. 1993;153:1595–1601.

    Article  CAS  PubMed  Google Scholar 

  58. Lee IM, Cook NR, Gaziana JM, et al. Vitamin E in the primary prevention of cardiovascular disease and cancer: the Womens Health Study: a randomised controlled trial. JAMA. 2002;288:322–333.

    Google Scholar 

  59. Hulley S, Grady D, Bush T, et al. Randomised trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. HERS research group. JAMA. 1998;280:605–613.

    Article  CAS  PubMed  Google Scholar 

  60. Rossouw JE, Anderson GL, Prentice RL, et al. Writing group for the Womens Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Womens Health Initiative RCT. JAMA. 2002;288:321–333.

    Article  CAS  PubMed  Google Scholar 

  61. Estruch R, Martinez-Gonzalez MA, Corella D, et al. PREDMED Study investigators. Effects of Mediterranean style diet on cardiovascular risk factors: a randomised trial. Ann Intern Med. 2006;145:1–11.

    PubMed  Google Scholar 

  62. de Lorgeril M, Salen P, Martin JL, et al. Mediterranean diet, traditional risk factors and rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99:779–785.

    PubMed  Google Scholar 

  63. Athyros VG, Papageorgiou AA, Athyrou VV, et al. Atorvastatin and micronised fenofibrtae alone and in combination in type 2 diabetes with combined hyperlipidemia. Diabetes Care. 2002;25:1198–1202.

    Article  CAS  PubMed  Google Scholar 

  64. Kashyap ML, McGovern ME, Berra K, et al. Long-term safety and efficacy of a once-daily niacin/lovastatin formulation for patients with dyslipidemia. Am J Cardiol. 2002;89:672–678.

    Article  CAS  PubMed  Google Scholar 

  65. Grundy SM, Vega GL, Yuan Z, et al. Effectiveness and tolerability of simvastatin and fenofibrate for combined hyperlipidemia (the SAFARI trial). Am J Cardiol. 2005;95:462–468.

    Article  CAS  PubMed  Google Scholar 

  66. Davidson MH. Reducing residual risk for patients on statin therapy: the potential role of combination therapy. Am J Cardiol. 2005;96:3K–13K.

    Article  CAS  PubMed  Google Scholar 

  67. The ACCORD Investigators. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010;362:1563–1574.

    Article  Google Scholar 

  68. Brown BG, 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.

    Article  CAS  PubMed  Google Scholar 

  69. Taylor AJ, Sullenberger LE, Lee HJ. Arterial Biology for the Investigation of the Treatment Effects of Cholesterol (ARBITOR-2): a double blind placebo controlled study of extended release niacin in atherosclerosis progression in secondary prevention. Patients treated with statins. Circulation. 2004;110:2–7.

    Article  CAS  Google Scholar 

  70. Taylor AJ, Lee HJ, Sullenberger LE. The effect of 24 months of combination statin and extended release niacin on carotid intima-media thickness (ARBITER-3). Curr Med Res Opin. 2006;22:2243–2250.

    Article  CAS  PubMed  Google Scholar 

  71. Ballantyne CM, Houri J, Notarbartolo A, et al. Ezetimibe Study Group. Effect of ezetimibe coadministered with atorvastatin in 628 patients with primary hypercholesterolemia: a prospective, randomized, double-blind trial. Circulation. 2003;107:2409–2415.

    Article  CAS  PubMed  Google Scholar 

  72. Davidson MH, McGarry T, Bettis R, et al. Ezetimibe coadministered with simvastatin in patients with primary hypercholesterolemia. J Am Coll Cardiol. 2002;40:2125–2134.

    Article  CAS  PubMed  Google Scholar 

  73. Goldberg AC, Sapre A, Liu L, Capece R, Mitchel YB. Ezetimibe Study Group. Efficacy and safety of ezetimibe coadministered with simvastatin in patients with primary hypercholesterolemia: a randomized, double-blind, placebo-controlled trial. Mayo Clin Proc. 2004;79:620–629.

    Article  CAS  PubMed  Google Scholar 

  74. Catapano AL, Davidson MH, Ballantyne CM, et al. Lipid altering efficacy of ezetimibe/simvastatin single tablet versus rosuvastatin in hypercholesterolemic patients. Curr Med Res Opin. 2006;22:2041–2053.

    Article  CAS  PubMed  Google Scholar 

  75. Ballantyne CM, Weiss R, Moccetti T, et al. EXPLORER study investigators. Efficacy and safety of rosuvastatin 40 mg alone or in combination with ezetimibe in patients at high risk of cardiovascular disease — results from EXPLORER study. Am J Cardiol. 2007;99:673–680.

    Article  CAS  PubMed  Google Scholar 

  76. Denke M, Pearson T, McBride P, et al. Ezetimibe added to ongoing statin therapy improves LDL-C goal attainment and lipid profile in patients with diabetes or metabolic syndrome. Diab Vasc Dis Res. 2006;3:393–102.

    Article  Google Scholar 

  77. Davidson MH, Ballantyne CM, Kerzner B, et al. Efficacy and safety of ezetimibe coadministered with statins. Int J Clin Pract. 2004;58:746–755.

    Article  CAS  PubMed  Google Scholar 

  78. Kastelein JJ, Akdim F, Stroes ES, et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med. 2008;358:1431–1443.

    Article  CAS  PubMed  Google Scholar 

  79. Rossebo AB, Pederson TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008;359:1343–1356.

    Article  PubMed  Google Scholar 

  80. Peto R, Emberson J, Landray M, et al. Analysis of cancer data from three ezetimibe trials. N Engl J Med. 2008;359:1357–1366.

    Article  CAS  PubMed  Google Scholar 

  81. Taylor AJ, Villimes TC, Stanek EJ, et al. Extended release niacin or ezetimibe and carotid intima media thickness. N Engl J Med. 2009;361:2113–2122.

    Article  CAS  PubMed  Google Scholar 

  82. Kastelein JP, Bots ML. Statin therapy with ezetimibe or niacin in high risk patients. N Engl J Med. 2009;361:2180–2183.

    Article  CAS  PubMed  Google Scholar 

  83. Stamler J, Wentworth D, Neaton JD. Is the relation 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  CAS  PubMed  Google Scholar 

  84. Chen Z, Peto R, Collins R, et al. Serum cholesterol concentration and coronary heart disease in a population with low cholesterol levels. BMJ. 1991;303:276–282.

    Article  CAS  PubMed  Google Scholar 

  85. Wilson PW, Anderson KM, Castelli WP. Twelve year incidence of CHD in middle aged adults during the era of hypertensive therapy. The Framingham Offspring Study. Am J Med. 1991;90:276–282.

    Article  Google Scholar 

  86. Assman G, Cullen P, Schulte H. The Munster Heart Study (PROCAM): results of follow up at 8th years. Eur Heart J. 1998;19(suppl. A):A2–A11.

    Google Scholar 

  87. Verschuuren WM, Jacobs DR, Bloemberg BP, et al. Serum total cholesterol and long-term coronary heart disease mortality in different culture: twenty five year follow up of the seven countries study. JAMA. 1995;274:131–136.

    Article  Google Scholar 

  88. Rifkind BM. Lipid research clinics coronary primary prevention trial: results and implications. Am J Cardiol. 1984;54:30C–34C.

    Article  CAS  PubMed  Google Scholar 

  89. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with Pravastatin in men with hypercholesterolaemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995;333:1301–1307.

    Article  CAS  PubMed  Google Scholar 

  90. Downs JR, Clearfield M, Weis S, 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  CAS  PubMed  Google Scholar 

  91. Sever PS, Dahlöf 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.

    Article  CAS  PubMed  Google Scholar 

  92. Ridker P, Danielson E, Francisco AH, et al. Rosuvastatin to prevent vascular events in men and women with elevated C reactive protein. N Engl J Med. 2008;359:2195–2207.

    Article  CAS  PubMed  Google Scholar 

  93. Mills EJ, Rachlis B, Wu P, et al. Primary prevention of cardiovascular mortality and events with statin treatments. J Am Coll Cardiol. 2008;52:1769–1781.

    Article  CAS  PubMed  Google Scholar 

  94. Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383–1389.

    Google Scholar 

  95. Sachs FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trials Investigators. CARE. N Engl J Med. 1996;335:1001–1009.

    Article  Google Scholar 

  96. Studer M, Briel M, Leimenstoll B, et al. Effect of different antilipidemic agents and diets on mortality: a systemic review. Arch Intern Med. 2005;165:725–730.

    Article  CAS  PubMed  Google Scholar 

  97. James H, O’Keefe Jr. Optimal LDL is 50-70 mg/dL. Lower is better and physiologically normal. J Am Coll Cardiol. 2004;43:11.

    Google Scholar 

  98. Ray KK, Cannon CP, McCabe CH, et al. Early and late benefits of high dose atorvastatin in patients with acute coronary syndromes: results from the PROVE-IT TIMI 22 trial. J Am Coll Cardiol. 2005;46:1405–1410.

    Article  CAS  PubMed  Google Scholar 

  99. NHS web site. The information centre for health and social care. Prescriptions dispensed in the community 1996-2006 [NS]. Department of Health. Available at: http://www.ic.nhs.uk/statisticsand-data-collections/primary-care/prescriptions/prescriptions-dispensed-in-the-community-1996-2006-%5Bns%5D. Last accessed February 24, 2010.

  100. NICE web site. Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. Available at: http://guidance.nice.org.uk/CG67. Last accessed February 24, 2010.

  101. Unwin N, Thomson R, O’Byrne AM, Laker M, Armstrong H. Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: cross sectional study of cardiovascular disease and risk factors. BMJ. 1998;317:1125–1130.

    CAS  PubMed  Google Scholar 

  102. Cullen P, Schulte H, Assman G. The Munster Heart Study. Total mortality in middle aged men is increased at low total and LDL-C concentration in smokers but not in nonsmokers. Circulation. 1997;96:2128–2136.

    CAS  PubMed  Google Scholar 

  103. Helaine E, Jones K, Ruotolo G, et al. Insulin resistance, the metabolic syndrome and risk of incident cardiovascular disease in nondiabetic American Indians. The Strong Heart Study. Diabetes Care. 2003;26:861–867.

    Article  Google Scholar 

  104. The ALLHAT Officers and Co-ordinators for the ALLHAT Collaborative research group. The antihypertensive and lipid lowering treatment for prevention of heart attack trial: major outcomes in moderately hypercholesterolemic hypertensive patients randomised to pravastatin or usual care. ALLHAT-LLT. JAMA. 2002;288:2998–3007.

    Article  Google Scholar 

  105. Farmer JA, Gotto AM Jr. The HPS: expanding the boundaries for high risk coronary disease prevention. Am J Cardiol. 2003;92:31–91.

    Article  Google Scholar 

  106. Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002; 360:1623–1630.

    Article  CAS  PubMed  Google Scholar 

  107. Afilalo J, Gustavo Duque, Steele R. Statins for secondary prevention in elderly patients - a hierarchical Bayesian meta-analysis. J Am Coll Cardiol. 2008;51:37–45.

    Article  CAS  PubMed  Google Scholar 

  108. McKeigue P M, Miller G J, Marmot MG. Coronary heart disease in South Asians overseas: a review. J Clin Epidemiol. 1989;42:597–609.

    Article  CAS  PubMed  Google Scholar 

  109. Spriston K, Primatesta P, eds. Risk Factors for Cardiovascular Disease. Health Survey for England 2003. Vol. 2. London: The Stationery Office; 2004.

    Google Scholar 

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Gupta, A., Guyomard, V., Zaman, M.J.S. et al. Systematic review on evidence of the effectiveness of cholesterol-lowering drugs. Adv Therapy 27, 348–364 (2010). https://doi.org/10.1007/s12325-010-0033-6

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