Atorvastatin calcium: PLACE IN THERAPY(2)
Of all the available treatment options for the management of elevated lipid levels, HMG-CoA reductase inhibitors have provided the strongest evidence yet that lowering plasma LDL-C level is accompanied with reduced risk of developing cardiovascular events and death from cardiovascular events . Although, as discussed earlier, there are animal data and some data in humans showing that HMG-CoA reductase inhibitors may affect other markers of cardiovascular disease, such as restoration of endothelial dysfunction , there is no evidence of a direct correlation between changes induced by HMG-CoA reductase inhibitors in these other markers and morbidity or mortality outcomes. The only strong and positive correlation that is predictive of favourable cardiovascular morbidity and mortality outcomes is a lowering of elevated LDL-C (and total cholesterol) levels. buy flovent inhaler
In the 4S trial, simvastatin therapy (20 to 40 mg/day) in patients with CAD resulted in an LDL-C reduction of 35%, which was accompanied by a 42% reduction in the risk of cardiovascular mortality and a 30% decrease in total mortality . In the CARE study, also conducted in patients with CAD, treatment with pravastatin 40 mg/day resulted in a 32% lowering of LDL-C, which was accompanied by a 26% reduction in the risk of cardiovascular death and nonfatal MI . Results from the WOSCOPS trial, conducted in men with hypercholesterolemia but without evidence of CAD, showed that treatment with pravastatin 40 mg/day resulted in LDL-C levels being reduced by 26%, and this was associated with a 32% reduction in the incidence of cardiovascular death and a 22% decrease in total mortality . Although information is not yet available on the effects of other HMG-CoA reductase inhibitors on cardiovascular morbidity and mortality, the above data are increasingly being considered as a class effect of the HMG-CoA reductase inhibitors group of drugs . All HMG-CoA reductase inhibitors decrease LDL-C levels, and clinical data demonstrate reduced cardiovascular morbitity and mortality associated with lower LDL-C levels. Clinical trials are underway that are investigating the effects of reduced lipoprotein levels with other HMG-CoA reductase inhibitors, including atorvastatin, on cardiovascular morbitity and mortality.