Low-density lipoprotein (LDL) plays a central, causal role in the development of coronary
heart disease (CHD) [
1
,
- Reiner Z.
- Catapano A.L.
- De Backer G.
- Graham I.
- Taskinen M.R.
- Wiklund O.
- et al.
ESC/EAS Guidelines for the management of dyslipidaemias: the task force for the management
of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis
Society (EAS).
Eur. Heart J. 2011; 32: 1769-1818
2
]. Evidence from genetic and observational studies and randomized controlled trials
(RCTs) in decades has demonstrated that higher levels of LDL cholesterol (LDL-C) are
associated with higher risk of CHD [
1
,
- Reiner Z.
- Catapano A.L.
- De Backer G.
- Graham I.
- Taskinen M.R.
- Wiklund O.
- et al.
ESC/EAS Guidelines for the management of dyslipidaemias: the task force for the management
of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis
Society (EAS).
Eur. Heart J. 2011; 32: 1769-1818
2
]. In contrast, a recent meta-analysis has shown that lowering of circulated LDL-C
dose-dependently results in reduction of CHD events. Every 1.0 mmol/L (~40 mg/dL) reduction in LDL-C is associated with a corresponding 22% decrease in CHD mortality
and morbidity [
[3]
]. Since publication of the first large randomized trial [
[4]
], the overwhelming body of evidence has demonstrated significant benefits of statins
in primary and secondary prevention of CHD [
1
,
- Reiner Z.
- Catapano A.L.
- De Backer G.
- Graham I.
- Taskinen M.R.
- Wiklund O.
- et al.
ESC/EAS Guidelines for the management of dyslipidaemias: the task force for the management
of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis
Society (EAS).
Eur. Heart J. 2011; 32: 1769-1818
2
]. Based on RCTs data [
5
,
6
], high-intensity statin, i.e. atorvastatin 80 mg and rosuvastatin 20 mg daily, is strongly recommended in CHD patients to reduce LDL-C for achievement
of maximal reduction of CHD events [
[2]
]. Despite convincing results, questions still remain about the benefits and the safety
of intensive lipid lowering with statin in Chinese population because of very rare
Chinese were enrolled in these studies, and it seems that population in East Asia
may have better statin responsiveness and lower baseline LDL-C compared to people
from North America and Europe. For example, pravastatin 10 to 20 mg/d could achieve approximately 25% reduction in LDL-C in Japanese [
[7]
], close to that found in WOSCOP study with a 40 mg daily dose of the agent [
[8]
]. Similarly, result of HPS2-THRIVE study indicated participants from China versus
Europe achieved lower LDL-C after identical lipid lowering drugs therapy [
[9]
]. The possible reason for the greater effect of statin in this population could partly
be the difference in statin pharmacokinetics between East Asia and western people
[
[10]
]. Furthermore, the baseline levels of and LDL-C values from studies of two East Asia
countries [
11
,
12
], i.e. Japan (2.94 ± 0.92 mmol/L) and Korea (2.84 ± 0.80 mmol/L), seems lower than those in western people with baseline LDL-C ranging from
3.30–3.50 mmol/L [
13
,
14
]. Although these studies were not based on direct comparison of statin responsiveness
or baseline lipid between population in East Asia and population elsewhere, it provided
some data for further research.Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to International Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- ESC/EAS Guidelines for the management of dyslipidaemias: the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS).Eur. Heart J. 2011; 32: 1769-1818
- 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults.J. Am. Coll. Cardiol. 2014; 63: 2889-2934
- Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials.Lancet. 2010; 376: 1670-1681
- Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).Lancet. 1994; 344: 1383-1389
- Intensive lipid lowering with atorvastatin in patients with stable coronary disease.N. Engl. J. Med. 2005; 352: 1425-1435
- Intensive versus moderate lipid lowering with statins after acute coronary syndromes.N. Engl. J. Med. 2004; 350: 1495-1504
- A comparison of low versus standard dose pravastatin therapy for the prevention of cardiovascular events in the elderly: the pravastatin anti-atherosclerosis trial in the elderly (PATE).J. Atheroscler. Thromb. 2001; 8: 33-44
- Influence of pravastatin and plasma lipids on clinical events in the West of Scotland Coronary Prevention Study (WOSCOPS).Circulation. 1998; 97: 1440-1445
- HPS2-THRIVE randomized placebo-controlled trial in 25 673 high-risk patients of ER niacin/laropiprant: trial design, pre-specified muscle and liver outcomes, and reasons for stopping study treatment.Eur. Heart J. 2013; 34: 1279-1291
- Rosuvastatin pharmacokinetics and pharmacogenetics in white and Asian subjects residing in the same environment.Clin. Pharmacol. Ther. 2005; 78: 330-341
- Comparison of effects of atorvastatin (20 mg) versus rosuvastatin (10 mg) therapy on mild coronary atherosclerotic plaques (from the ARTMAP trial).Am. J. Cardiol. 2012; 109: 1700-1704
- Impact of early statin initiation on secondary prevention in Japanese patients with coronary artery disease.J. Cardiol. 2011; 57: 172-180
- MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial.Lancet. 2002; 360: 7-22
- Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial.JAMA. 2004; 292: 1307-1316
- Prevalence of dyslipidaemia in patients treated with lipid-lowering agents in China: results of the DYSlipidemia International Study (DYSIS).Atherosclerosis. 2014; 235: 463-469
- The effect of moderate-dose versus double-dose statins on patients with acute coronary syndrome in China: results of the CHILLAS trial.Atherosclerosis. 2014; 233: 707-712
- Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines.Circulation. 2004; 110: 227-239
- Baseline low-density lipoprotein cholesterol is an important predictor of the benefit of intensive lipid-lowering therapy: a PROVE IT-TIMI 22 (pravastatin or atorvastatin evaluation and infection therapy-thrombolysis in myocardial infarction 22) analysis.J. Am. Coll. Cardiol. 2008; 52: 914-920
- Mild to moderate muscular symptoms with high-dosage statin therapy in hyperlipidemic patients–the PRIMO study.Cardiovasc. Drugs Ther. 2005; 19: 403-414
Article info
Publication history
Published online: November 23, 2015
Accepted:
November 22,
2015
Received:
November 18,
2015
Identification
Copyright
© 2015 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
