HMG reductase inhibitors have significant desirable effects on patients with dyslipidemia. Multiple factors are involved in these desirable effects. Other factors that might play a role in the risk of coronary artery disease are fibrinogen concentration, homocysteine, Lp (a), small dense LDL, insulin resistance, and infection with chlamydia.
High-dose reductase inhibitors may be indicated in select patients. The ideal end point may be 150 mg/dL for adults.
Get full access to this article
View all access options for this article.
References
1.
Martin, MJ, Hulley SB, Browner WS, et al: Serum cholesterol, blood pressure, and mortality: Implications from a cohort of 361,662 menLancet2:933-939, 1986.
2.
Kannel WB, Castelli WP, Gordon T., et al: Serum cholesterol, lipoproteins, and the risk of coronary heart disease . Ann Intern Med11:1662-1746, 1938 .
3.
Scandinavian Simvastatin Survival Study Group.Randomised trial of cholesterol lowering in 4,444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4S)Lancet344:1383-1389, 1994 .
4.
Shepherd J., Cobbe SM, Ford I., et al, for the West of Scotland Coronary Prevention Study Group: Prevention of coronary heart disease with pravastatin in men with hypercholesterolemiaN Engl J Med333:1301-1307, 1995.
5.
Sacks FM, Pfeffer MA, Moye LA, et al, for the Cholesterol and Recurrent Events Trial Investigators: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med335:1001-1009, 1996.
6.
Brown G., Albers JJ, Fisher LD, et al: Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein BN Engl J Med323:1289-1298, 1990.
7.
Watts, GF, Lewis B., Brunt Jnh, et al: Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St. Thomas' Atherosclerosis Regression Study (STARS)Lancet339:563-569, 1992.
8.
Waters D., Higginson L., Gladstone P., et al : Effects of monotherapy with an HMG-CoA reductase inhibitor on the progression of coronary atherosclerosis as assessed by serial quantitative arteriography: The Canadian Coronary Atherosclerosis Intervention TrialCirculation89:959-968, 1994.
9.
Blankenhorn DH , Azen SP, Kramsch DM, et al: Coronary angiographic changes with lovastatin therapy : The Monitored Atherosclerosis Regression Study (MARS)Ann Intern Med119:969-976, 1993.
10.
Kane JP, Malloy MJ, Ports TA, et al: Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimensJAMA264:3007-3012, 1990.
11.
Haskell WL, Alderman EL, Fair JM, et al: Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women and coronary artery disease: The Stanford Coronary Risk Intervention Project (SCRIP)Circulation89:979-990, 1994.
12.
Schuler G., Hambrecht R., Schlierf G., et al: Regular physical exercise and low-fat diet: Effects on progression of coronary artery diseaseCirculation86:1-11, 1992.
13.
Ornish D., Brown SE, Scherwitz LW: Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart TrialLancet336:310-318, 1990.
14.
Fuster V., Badimon L., Badimon JJ, et al: The pathogenesis of coronary artery disease and the acute coronary syndromesN Engl J Med326:310-318, 1992.
15.
Loscalzo J. : Regression of coronary atherosclerosisN Engl J Med323:1337-1339, 1990 .
16.
Schmieder RE , Schobel HP: Is endothelial dysfunction reversible?Am J Cardiol76:117A-121A, 1995.
17.
Roberts WC: Preventing and arresting coronary atherosclerosisAm Heart J130:580-600, 1995.
Ubbink JB, Vermaak WJ, van der Merwe A., et al: Vitamin B-12, vitamin B-6, and folate nutritional status in men with hyperhomocysteinemiaAm J Clin Nutr57:47-53, 1993.
20.
Grundy SM: Small LDL, atherogenic dyslipidemia, and the metabolic syndromeCirculation95:1-4, 1997.
21.
Heinonen TM , Stein E., Weiss SR, et al: The lipid-lowering effects of atorvastatin, a new HMG-CoA reductase inhibitor: Results of a randomized, double-masked studyClin Ther18:5, 1996.
22.
Davidson MH , Stein EA, Dujovne CA, et al: The efficacy and six week tolerability of simvastatin 80 and 160 mg/dayAm J Cardiol79:38-42, 1997.
23.
Tamai O., Matsuoka H., Itabe H., et al: Single LDL apheresis improves endothelium-dependent vasodilatation in hypercholesterolemic humansCirculation95:76-82, 1997.
