Lipid-lowering therapy

Recent studies have significantly expanded niches for the use of lipid-lowering therapy. If only recently the expediency of prescribing statins was justified by the presence of cardiovascular diseases, at present, lipid-lowering therapy is also indicated as a means of primary prophylaxis. A convincing evidence of this is the recently completed prematurely large randomized ASCOT – LL study [92]. The ASCOT – LL study on the efficacy of primary prevention of atorvastatin included 10305 patients, 40–79 years old, with moderate arterial hypertension, no history of IHD, but at least 3 risk factors for its development, in addition to arterial hypertension, with moderate hyperlipidemia (total plasma cholesterol <6.5 mmol / l, plasma triglycerides <4.5 mmol / l). In middle-aged patients with arterial hypertension, who, according to the existing recommendations, statin prescription is optional, atorvastatin for 3.5 years significantly reduced the combined risk of nonfatal heart attack and death from coronary heart disease (–36%), the total risk of cardiovascular complications and the need for revascularization ( –21%), risk of coronary complications (–29%), strokes (–27%) and the occurrence of stable coronary artery disease (–41%). In this way,According to the results of the ASCOT – LL study, there is an obvious need for the static use of statins in middle-aged patients with arterial hypertension and additional cardiovascular risk factors – even with normal or slightly elevated levels of atherogenic plasma lipid spectrum. However, in such patients, the positive effect of statins on the prognosis is not as impressive as in those with proven coronary artery disease and severe hyperlipidemia. A meta-analysis published in 2009, which compared statins with placebo, other active therapies or standard treatment of people without CVD, but with risk factors for their development, demonstrated the advisability of statin use in primary prevention. 10 recently completed randomized clinical trials, (70388 people, mean age 63 years,34% of women, 23% of patients with diabetes, the average duration of observation was 4.1 years, the initial LDL level was 3.63 mmol / l.) The primary end point of the meta-analysis was mortality from any cause. The secondary endpoints were: a) a combination of major coronary complications (death from coronary heart disease or nonfatal myocardial infarction), b) a combination of major cerebrovascular complications (fatal and nonfatal stroke). Lipid-lowering therapy significantly reduced overall mortality by 12%. The reduction in the risk of major coronary complications was 30%, of the main cerebrovascular complications – 19%. The risk of developing endpoints did not differ in the further analysis by subgroups depending on age (younger than 65 and over 65), gender, and the presence of diabetes. In this way,This meta-analysis demonstrated the effectiveness of statins in primary prevention of CVD, comparable to the use of statins in secondary prophylaxis in reducing the risk of death from all causes, as well as the main coronary and cerebrovascular complications.

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