Téma: Clinical pharmacology

What target level of ldl cholesterol is based on the evidence from clinical randomized trials?

Ivan Tkáč

The most recent 2004 NCEP-ATP III Report recommends to achieve target levels of LDL cholesterol (LDLC) < 2.6 mmol/l in patients with verified atherosclerosis or type 2 diabetes. In the very high risk patients, among them patients with acute coronary syndrome (ACS) or previous myocardial infarction and diabetes, target LDLC level of < 1.8 mmol/l is recommended to consider.The present article analyses data from four studies published in 2004-2005, which compared maximal dose with conventional dose cholesterol lowering treatment with statins. Two of these studies included patients with ACS (PROVE-IT and A-Z Trial), while two studies included patients with stable coronary heart disease (TNT and IDEAL). We performed a metaanalysis of the four studies, which included 27 548 patients. The average LDLC level was 1.9 mmol/l in intensively treated groups, while in the conventional treatment groups it was 2.5 mmol/l. This difference led to a significant reduction of coronary mortality by 14 %, of the non-fatal myocardial infarction incidence by 15 %, and to reduction of stroke incidence by 17 %. In conclusion, LDLC lowering to ≅ 2.0 mmol/l is sufficiently evidence-based by the most recent randomized trials, which compared the maximal and conventional doses of statins. This therapeutic goal could be achieved either by using high dose statin treatment, or by using combination treatment with basal dose statin and ezetimibe – an inhibitor of intestinal cholesterol resorbtion.

Ročník 2006  Témy časopisu Internal medicine 4 / 2006

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3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
4. Jurkovičová O, Spitzerová H, Cagáň S. Komorové arytmie a náhla srdcová smrť pri akútnom infarkte myokardu. Bratisl Lek Listy 1997; 98: 379-389.
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