Lege Artis Medicinae

[Secondary prevention of patients with ischaemic heart disease - The reduction of LDL cholesterol level and the regression of atherosclerosis]

BÁRCZI György, MERKELY Béla

OCTOBER 21, 2007

Lege Artis Medicinae - 2007;17(10)

[The authors review the options of secondary medical prevention in patients with ischaemic heart disease, stressing the need and safety of using statins. The beneficial effect of statin therapy on cardiovascular morbidity and mortality and the clinical benefit of the greatest possible reduction in LDL cholesterol level are presented. The atherosclerotic plaque regression achieved by a high-intensity statin therapy in the ASTEROID trial is also briefly reviewed.]

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[Hypercholesterolemia is one of the most important major risk factors that can be most influenced. Its treatment is based on guidelines. In 2013 in Hungary the common guideline of 17 societies (MKKK) as well as the recommendations of EAS/ESC and those of IAS are at disposal. These recommendations have established similar risk categories and strict LDL-cholesterol goals (<1.8 mmol/l). On 12 November, 2013, in the USA after a long drawn debate the AHA/ACC - without any lipid association - issued a new cholesterol (Ch) guideline, which drasticly differs from the existing national and European recommendations. According to AHA/ACC each patient with cardiovascular disease or diabetes should be treated with statin, irrespective of the Ch value, All patients with a LDL-Ch level over 4.9 mmol/l should also be treated with statin. In primary prevention those with values between 1.8-4.9 (LDL-Ch), or 3.5-8.0 mmol/l (Ch) would also be given statin, if their risk is more than 7.5%, with the new calculator system (“Statin Benefit Groups”). These recommendations would eliminate the classic risk categories (very-high, high, moderate risk), would abolish the system of treatment goals, as well as the regular Ch test. The non-statin therapy is not supported even in combinations. A big part of the population with low Ch level would also receive statin based on the results with the calculator, meaning that in the USA the number of those treated might double. Not only the European (e.g. EAS/,ESC) but even American societies (National Lipid Association 2013-2014) (e.g. NLA) oppose to the new guideline of AHA/ACC.]

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