From cholesterol levels to risk analysis: the revolution of the Heart Protection Study

• Published in: International Congress series Vol. 1253; pp. 217 - 222
• Main Authors: Gensini, G.F., Dilaghi, B.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.08.2003
• Subjects: Cardiovascular risk; Cholesterol; Lipid-lowering agents; Lipid-lowering agents; Cholesterol; Cardiovascular risk
• ISSN: 0531-5131; 1873-6157
• DOI: 10.1016/S0531-5131(03)00129-8

Prospective epidemiological studies in the general population show that a roughly linear positive association exists between CHD risk and blood total cholesterol concentration, without any evidence of a “threshold” level below which lower cholesterol is not associated with lower risk. Recently, the National Cholesterol Education Program (NCEP), Adult Treatment Panel III (ATP III) published updated guidelines for the treatment of lipid disorders, broadly expanding the number of patients eligible for therapy. The MRC/BHF Heart Protection Study (HPS) including over 20,500 subjects is the largest trial of statin therapy ever conducted; its results have clearly confirmed the results of the previous trials and support the use of statin therapy in secondary prevention. Practically, all patients with vascular disease would benefit to different extents from statins, but maybe clinicians will choose to initiate and continue treatment with statins in high-risk individuals without routine lipid measurements. In primary prevention, the data are not as convincing and generalizations cannot be made as to whether, and in which subgroup, drug therapy to lower LDL cholesterol should be initiated. There are important cost implications to consider and the use of statin therapy has to be decided on an individual basis, particularly in those with high or very high LDL cholesterol levels and/or with multiple risk factors rendering them at high short-and long-term risk of coronary heart disease (CHD). There is evidence of a ‘care gap’ in translating trial data into practice, even in secondary prevention, and this needs closing in order to improve patient outcomes.