Statin Therapy for Your Heart

One more article on statin therapy? Yes, one more article. If you have had high cholesterol level then you know quite a bit about statin therapy. Statin therapy is extensively used for the management of high cholesterol level and in the management of coronary artery disease. One of the cholesterols is LDL (low-density lipoprotein cholesterol), also known as the “bad” cholesterol.

Recently, an article in the Canadian Medical Association Journal (CMAJ) discussed the efficacy and safety of intensive statin therapy in patients with high LDL cholesterol and coronary artery disease.

High LDL levels are associated with an increased risk for heart disease. Your doctor orders LDL testing as part of your routine check-up and it is often the first step in determining whether an individual is at risk for developing heart disease. In the management of high cholesterol level and coronary artery disease, LDL levels are often the major focus of cholesterol lowering diets and drugs.

The CMAJ article says high cholesterol level is the most important modifiable risk factor for myocardial infarction (heart attack) worldwide. High cholesterol level is directly related to high risk of dying from coronary artery disease. Studies have shown that reducing LDL cholesterol with statin therapy reduces events like heart attack by 21 per cent and death by 12 per cent.

Appropriate diet is the first line of treatment in the management of high cholesterol and high LDL. Avoid foods high in saturated fats and trans-fatty acids. Next line of treatment is cholesterol lowering medications. Commonest of these are statins. Statins reduce the bad cholesterol LDL by 30 to 50 per cent.

How low should the LDL blood level be to lower the risk of adverse events in patients with coronary artery disease? Current Canadian and American guidelines advocate LDL levels below 2.0 mmol/L in patients with coronary artery disease. Europeans guidelines differ a bit. They recommend LDL of 2.5 mmol/L in these patients.

Who should receive intensive statin therapy to lower the LDL blood level?

Analyses conducted by the authors of CMAJ article supports the use of more intensive statin regimens in patients with established coronary artery disease. What about patients who have LDL level higher than 2.0 mmol/L but have no coronary artery disease? The authors say there is insufficient evidence to advocate treating to particular LDL targets (i.e. 2.0 mmo/L) in patients without established coronary artery disease. What if these patients (the ones without coronary artery disease) have other risk factors making them prone to coronary artery disease? The authors say that there were too few clinical events in these trials to make definitive conclusions.

The authors of the article found more intensive statin therapy safe and well-tolerated. They also came to the conclusion that it helps in the prevention of heart attack and stroke in patients with known coronary artery disease, irrespective of their baseline LDL cholesterol levels. They said further research is needed to define:
-optimal LDL cholesterol targets (is 2.0 mmol/L the right target number?),
-the role of more intensive statin therapy in patients without coronary artery disease and
-the role of combination statin therapy (usually low LDL is achieved using two types of statins).

It would be a good idea to find out from your physician what your LDL level is every time you get your cholesterol level checked. If it is above 2.0 mmol/L then ask if you need statin therapy.

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