Lipid Lowering Evidence - Cardiovascular Mortality Reduction:
Optimization of cardiac risk factors and lipid abnormalities can contribute
to global cardiovascular morbidity and mortality reduction. The evidence
and the cost benefit, particularly in 2° prevention, are compelling.
Delays and gaps in implementation compromise patient outcomes and represent
a huge lost opportunity to reduce hospitalization and health care costs
and diminish the burden of cardiovascular disease.
The clinical benefit of lipid lowering was examined in a meta-analysis
of 8 double blind placebo controlled secondary prevention trials up to
an including HPS (6) in 54,381 subjects treated with simvastatin, pravastatin,
lovastatin or fluvastatin (8) Compared to placebo a mean 20% cholesterol
reduction was associated with a 30% reduction in CHD events and a 17%
reduction in all cause mortality. The principal secondary prevention
trials, 4S (3), CARE (4), and LIPID (5) enrolled patients to a maximum
age of 75 years. Patients > 65 years old had similar benefits as compared
to younger patients.