Circulation. 1998;97:1436-1439
(Circulation. 1998;97:1436-1439.)
© 1998 American Heart Association, Inc.
Statin Trials and Goals of Cholesterol-Lowering Therapy
Scott M. Grundy, MD, PhD
From the Departments of Clinical Nutrition and Internal Medicine and the
Center for Human Nutrition, University of Texas Southwestern Medical Center,
Dallas.
Correspondence to Scott M. Grundy, MD, PhD, Departments of Clinical Nutrition and Internal Medicine and the Center for Human Nutrition, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235-9052.
Key Words: Editorials • cholesterol • trials
Hydroxymethylglutaryl
coenzyme A reductase inhibitors (statins) are a
breakthrough in the treatment of high serum cholesterol.
Several recent clinical trials1 2 3 demonstrate
that statins can substantially reduce both morbidity and mortality from
CHD. They are becoming a mainstay in management of patients with
established CHD (secondary prevention), and they hold promise for
high-risk patients without evident CHD (primary prevention). The
introduction of statins occurred about the same time as the initiation
of the NCEP; this program is a national effort to increase public and
professional awareness of the dangers of high serum
cholesterol and to emphasize the benefits of reducing serum
cholesterol concentrations. Besides the NCEP's public
health effort4 to lower serum
cholesterol levels in the general public through
modification of life habits, the NCEP has established guidelines for
cholesterol management in both secondary prevention and
high-risk primary prevention.5 6 These guidelines
identify LDL cholesterol as the primary target of therapy,
and they specify goals for LDL cholesterol–lowering
therapy. For example, the NCEP recommended that high-risk patients who
have elevated LDL cholesterol levels but not clinical CHD
or other atherosclerotic disease should have their LDL
cholesterol concentration reduced to <130
mg/dL.5 6 For patients with CHD or other
atherosclerotic diseases, the goal of NCEP is an LDL
cholesterol of 
100 mg/dL.5 6 These
therapeutic goals derive from judgments based on epidemiological data
and clinical trial results available at the time of reporting.
Recent statin trials1 2 3 provide a wealth of data
documenting the benefit of cholesterol-lowering therapy in
both primary and secondary prevention. A major . . . [Full Text of this Article]
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47(10):
2134 - 2147.
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25(10):
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46(6):
1163 - 1171.
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|
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|
|
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111(18):
2280 - 2281.
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|
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|
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161(4):
352 - 358.
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|
|
|
|
|
|
|
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19(11):
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|
|
|
|
|
|
|
C. M. Welzig, D.-G. Shin, H.-J. Park, Y.-J. Kim, J. P. Saul, and J. B. Galper
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108(22):
2743 - 2746.
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|
|
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Genome-wide scan for quantitative trait loci influencing LDL size and plasma triglyceride in familial hypertriglyceridemia
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November 1, 2003;
44(11):
2161 - 2168.
[Abstract]
[Full Text]
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|
|
|
|
|
|
|
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107(15):
2059 - 2065.
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|
|
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|
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|
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|
|
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23(1):
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|
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51(8):
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|
|
|
|
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143(6):
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87(5):
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|
|
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162(4):
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|
|
|
|
|
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87(2):
423 - 437.
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|
|
|
|
|
|
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D. H. Walter, S. Fichtlscherer, M. B. Britten, P. Rosin, W. Auch-Schwelk, V. Schachinger, and A. M. Zeiher
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J. Am. Coll. Cardiol.,
December 1, 2001;
38(7):
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|
|
|
|
|
|
|
D.H Walter, V Schachinger, M Elsner, S Mach, S Dimmeler, W Auch-Schwelk, and A.M Zeiher
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April 1, 2001;
22(7):
587 - 595.
[Abstract]
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|
|
|
|
|
|
|
J. S. Forrester, C. N. Bairey-Merz, and S. Kaul
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J. Am. Coll. Cardiol.,
October 1, 2000;
36(4):
1419 - 1425.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. L. Knatterud, Y. Rosenberg, L. Campeau, N. L. Geller, D. B. Hunninghake, S. A. Forman, J. S. Forrester, F. L. Gobel, J. A. Herd, A. Hickey, et al.
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July 11, 2000;
102(2):
157 - 165.
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|
|
|
|
|
|
|
S. M. Haffner
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July 4, 2000;
102(1):
2 - 4.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. Rajaratnam, H. Gylling, and T. A. Miettinen
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J. Am. Coll. Cardiol.,
April 1, 2000;
35(5):
1185 - 1191.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Gotto Jr, E. Whitney, E. A. Stein, D. R. Shapiro, M. Clearfield, S. Weis, J. Y. Jou, A. Langendorfer, P. A. Beere, D. J. Watson, et al.
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)
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February 8, 2000;
101(5):
477 - 484.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. H. Lee, J. I. Cleeman, S. M. Grundy, C. Gillett, R. C. Pasternak, J. Seidman, and C. Sennett
Clinical Goals and Performance Measures for Cholesterol Management in Secondary Prevention of Coronary Heart Disease
JAMA,
January 5, 2000;
283(1):
94 - 98.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-J. Park and J. B. Galper
3-Hydroxy-3-methylglutaryl CoA reductase inhibitors up-regulate transforming growth factor-beta signaling in cultured heart cells via inhibition of geranylgeranylation of RhoA GTPase
PNAS,
September 28, 1999;
96(20):
11525 - 11530.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. H. Knopp
Drug Treatment of Lipid Disorders
N. Engl. J. Med.,
August 12, 1999;
341(7):
498 - 511.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. M. Grundy, J. I. Cleeman, B. M. Rifkind, L. H. Kuller, and for the Coordinating Committee of the National Cho
Cholesterol Lowering in the Elderly Population
Arch Intern Med,
August 9, 1999;
159(15):
1670 - 1678.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. B. Rubins, S. J. Robins, D. Collins, C. L. Fye, J. W. Anderson, M. B. Elam, F. H. Faas, E. Linares, E. J. Schaefer, G. Schectman, et al.
Gemfibrozil for the Secondary Prevention of Coronary Heart Disease in Men with Low Levels of High-Density Lipoprotein Cholesterol
N. Engl. J. Med.,
August 5, 1999;
341(6):
410 - 418.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I.U. Haq, L.E. Ramsay, P.R. Jackson, and E.J. Wallis
Prediction of coronary risk for primary prevention of coronary heart disease: a comparison of methods
QJM,
July 1, 1999;
92(7):
379 - 385.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Stankler
Goals for Cholesterol Lowering
Circulation,
May 11, 1999;
99
(18):
2476 - 2479.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Fazio, M. F. Linton, and S. M. Grundy
On the Relationship Between Cholesterol Lowering and Coronary Disease Event Rate • Response
Circulation,
December 8, 1998;
98(23):
2645 - 2646.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. A. Jacobson, J. R. Schein, A. Williamson, and C. M. Ballantyne
Maximizing the Cost-effectiveness of Lipid-Lowering Therapy
Arch Intern Med,
October 12, 1998;
158(18):
1977 - 1989.
[Abstract]
[Full Text]
[PDF]
|
|
|
