The benefits of cholesterol control

The benefits of cholesterol control

A clear benefit has been demonstrated in relation to diet and drug therapy aimed at reducing serum cholesterol (cholesterol). A large number of large-scale studies on primary and secondary prevention with the use of HMG-CoA reductase inhibitors (statins) have demonstrated a significant reduction in the incidence of CHD and MI in various populations. The studies included patients with established CHD; with KBS and other occlusal PAD or DM, but normal levels of cholesterol; without clinically overt atherosclerotic CVD and with moderate levels of cholesterol and LDL cholesterol; elderly people at risk of vascular diseases and people with hypertension with moderate or low levels of cholesterol.

A meta-analysis of 2005, which included 14 randomized clinical trials (n = 90,056), showed that statin therapy safely reduced the 5-year incidence of major coronary events, coronary revascularization and MI by 20% while LDL cholesterol decreased by 1 mmol / l, regardless of its baseline, age, gender, or previous disease, and without any increase in the incidence of cancer. This risk reduction is linear, resulting in a comparable risk reduction across the entire lipid spectrum.

Prolonged daily adherence to therapy is likely to be more important in determining final efficacy than any differences between the effects of statins. A recent analysis of 4 large randomized studies of patients already having the disease showed that intensive therapy with large doses of statins clearly exceeds the effectiveness of standard dose treatment in reducing the risk of MI, cerebral stroke (MI) or any cardiovascular event (SSSob). Some researchers, but not all, support the early prescription of statin therapy after myocardial infarction or coronary artery bypass grafting.

Gemfibrozil (a drug that increases HDL cholesterol and reduces TG levels) reduces the risk among people with high levels of cholesterol and LDL cholesterol. In the VA-HIT study (Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial), a 22% decrease in cardiovascular events (SSSob) was observed in the treatment of gemfibrozil in persons with low cholesterol cholesterol (<40 mg / dL, or 1 mmol / L) , and this risk reduction occurred in the absence of any significant change in the content of LDL cholesterol. These data confirm the ability of drugs to influence cholesterol and HD. Nicotinic acid can increase the level of cholesterol cholesterol and reduce ssob associated with coronary artery disease.

Another class of drugs that can increase the level of cholesterol-free cholesterol is currently in a clinical trial. BPHEC inhibitors can increase the level of HDL cholesterol and moderately reduce the level of LDL cholesterol. However, despite the expectation of positive outcomes for disease outcomes from the use of BPECS inhibitors in combination with statins, the recent cessation of the development of one of BPECS inhibitors, associated with its apparent PE, underscores the need for long-term clinical trials on the effect of BPECS inhibitors on HDL cholesterol.

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