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There are reasons to believe that greater benefits in CAD morbidity and mortality can be achieved with greater reductions in LDL-C levels. Meta-analysis of clinical trials data, including the recent data with HMG-CoA reductase inhibitors, demonstrates that the magnitude of benefit (lower CAD morbidity and mortality and total mortality risk) is directly related to the degree of cholesterol reduction . It has been estimated that for every 1% reduction in LDL-C levels there is approximately a 2% to 3% reduction in CAD risk . Results from LRC-CPPT show that an 11% reduction in LDL-C was associated with a 19% decrease in nonfatal MI and/or death due to CAD . For patients who achieved a 35% reduction in LDL-C levels, the predicted decrease in non-fatal MI and/or death due to CAD was 49%.

The Post Coronary Artery Bypass Graft trial (Post-CABG), the only published randomized, controlled trial available that was designed to show a difference in event reduction among levels of LDL-C reduction, demonstrated that patients with a greater reduction in LDL-C level (treated to a target LDL-C level of 2.4 mmol/L) experienced less plaque progression and required fewer surgical interventions (PTCA and coronary artery bypass graft) compared with patients with lesser reductions in LDL-C levels (treated to a target LDL-C level ofn 3.4 mmol/L) . A recent subanalysis of the 4S study showed that patients who achieved LDL-C target levels below 2.6 mmol/L had the greatest reduction in major coronary events . There are suggestions that to minimize the risk of future cardiovascular events (in patients with CAD or high risk of CAD), earlier intervention and a more aggressive LDL-C reduction strategy, possibly by combination therapy or more efficacious medication, are needed in conjunction with other risk factor modifications . These data lend further support to the evidence that the lower the LDL-C level the greater the benefit conferred. buy asthma inhalers

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