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(Circulation. 2002;106:2039.)
© 2002 American Heart Association, Inc.

Editorial

Low-Density Lipoprotein Lowering and Atherosclerosis Progression

Does More Mean Less?

Prediman K. Shah, MD

From the Division of Cardiology and Atherosclerosis Research Center, Burns and Allen Research Institute, Cedars Sinai Medical Center, Los Angeles, Calif.

Correspondence to P.K. Shah, MD, Director, Division of Cardiology and Atherosclerosis Research Center, Room 5347, 8700 Beverly Blvd, Los Angeles, CA 90048. E-mail shahp@cshs.org

Key Words: Editorials • lipoproteins • atherosclerosis • statins

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Statins (hydroxymethylglutaryl coenzyme A [HMG-CoA] reductase inhibitors) have been shown to significantly reduce cardiovascular clinical events in a variety of patient categories, ranging from patients with established cardiovascular disease to those at risk for cardiovascular disease.^1–6 Clinical benefits of statin therapy have also been shown across a wide range of pretreatment cholesterol and low-density lipoprotein cholesterol (LDL-C) levels, warranting recent recommendations that statin therapy should be considered in all high-risk subjects, regardless of baseline cholesterol levels.⁶ While it is generally agreed that most of the clinical benefits of statins are related to cholesterol/LDL-C 2lowering, other biological effects of statins that do not depend on LDL-C lowering, the so-called pleiotropic effects, including effects on non-LDL lipid fractions, have also been implicated, mostly based on indirect data and preclinical findings.^7,8 Two important questions with respect to the statins are 1) is the magnitude of clinical benefit from statins related to the magnitude of LDL-C lowering or, in other words, does a lower LDL-C mean greater benefit, and if so, what is the lowest LDL-C level below which no further benefit can be expected? and 2) do statins differ from each other in terms of clinical benefit, and if so, is that related to unique properties of a statin or simply due to differing potencies in LDL-C lowering?

See p 2055

In this issue of Circulation, Taylor and colleagues⁹ attempted to address the issue of magnitude of LDL-C lowering and its effect on changes in carotid-intima media thickness (IMT) in a cohort . . . [Full Text of this Article]

Related Article:

ARBITER: Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol: A Randomized Trial Comparing the Effects of Atorvastatin and Pravastatin on Carotid Intima Medial Thickness

Allen J. Taylor, Steven M. Kent, Patrick J. Flaherty, Louis C. Coyle, Thor T. Markwood, and Marina N. Vernalis
Circulation 2002 106: 2055-2060. [Abstract] [Full Text]

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