Cardiovascular disease (CVD) is the leading cause of death in Italy and in the 28 countries of the European Union. Low-density lipoprotein cholesterol (LDL-C) is a key CVD risk factor. Results from the randomized intervention clinical trials with lipid-lowering agents strongly suggest that the reduction of fatal and non-fatal CVD events is associated with the absolute LDL-C reduction, in mg/dl or mmol/L, regardless of the lipid-lowering agent studied. Statins, by decreasing cholesterol synthesis in the liver, are associated with a large LDL-C reduction and with robust and convincing evidence of a significant reduction of all-cause, CVD and coronary heart disease (CHD) mortality. An LDL-C reduction by 39 mg/dl (1 mmol/L) on statin therapy is associated with a decrease by 10% (p<0.0001) in all-cause mortality, by 20% (p<0.0001) in CHD deaths and by 24% (p<0.0001) in major cardiovascular events. These results were often observed in secondary CVD prevention patients (4S, HPS and LIPID trials), independently of patients’ gender and age, in patients on primary CVD prevention at high CV risk and in patients with type two diabetes. In patients with diabetes a 39 mg/dl (1 mmol/L) LDL-C reduction is associated with a decrease by 9% (p=0.02) in all-cause mortality, by 12% (p=0.03) and 13% (p=0.008) in deaths due to CHD and CVD causes respectively, and by 21% (p<0.0001) in major cardiovascular events. Data on CVD and CHD mortality regarding ezetimibe, fibrates and PCSK9 inhibitors are not nearly as robust as those with statin therapy: a significant reduction with these lipid-lowering agents has been observed in combined clinical endpoints including fatal and non-fatal CVD events while no significant reduction in all-cause, CVD or CHD mortality has been reported. This lack of positive results on CVD and CHD mortality should be interpreted in the light of remarkable changes in the background therapy to prevent CVD events seen in patients enrolled in the more recent trials where aggressive antihypertensive, antiplatelet and lipid-lowering therapy are common enrollment criteria for both control and active treatment groups.

I farmaci che riducono la mortalità: gli ipolipemizzanti

BIGOLIN, PAOLA;PREVIATO, LORENZO;SANDRA BERTOCCO;ALBERTO ZAMBON
2017

Abstract

Cardiovascular disease (CVD) is the leading cause of death in Italy and in the 28 countries of the European Union. Low-density lipoprotein cholesterol (LDL-C) is a key CVD risk factor. Results from the randomized intervention clinical trials with lipid-lowering agents strongly suggest that the reduction of fatal and non-fatal CVD events is associated with the absolute LDL-C reduction, in mg/dl or mmol/L, regardless of the lipid-lowering agent studied. Statins, by decreasing cholesterol synthesis in the liver, are associated with a large LDL-C reduction and with robust and convincing evidence of a significant reduction of all-cause, CVD and coronary heart disease (CHD) mortality. An LDL-C reduction by 39 mg/dl (1 mmol/L) on statin therapy is associated with a decrease by 10% (p<0.0001) in all-cause mortality, by 20% (p<0.0001) in CHD deaths and by 24% (p<0.0001) in major cardiovascular events. These results were often observed in secondary CVD prevention patients (4S, HPS and LIPID trials), independently of patients’ gender and age, in patients on primary CVD prevention at high CV risk and in patients with type two diabetes. In patients with diabetes a 39 mg/dl (1 mmol/L) LDL-C reduction is associated with a decrease by 9% (p=0.02) in all-cause mortality, by 12% (p=0.03) and 13% (p=0.008) in deaths due to CHD and CVD causes respectively, and by 21% (p<0.0001) in major cardiovascular events. Data on CVD and CHD mortality regarding ezetimibe, fibrates and PCSK9 inhibitors are not nearly as robust as those with statin therapy: a significant reduction with these lipid-lowering agents has been observed in combined clinical endpoints including fatal and non-fatal CVD events while no significant reduction in all-cause, CVD or CHD mortality has been reported. This lack of positive results on CVD and CHD mortality should be interpreted in the light of remarkable changes in the background therapy to prevent CVD events seen in patients enrolled in the more recent trials where aggressive antihypertensive, antiplatelet and lipid-lowering therapy are common enrollment criteria for both control and active treatment groups.
2017
File in questo prodotto:
Non ci sono file associati a questo prodotto.
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/3280104
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact