Statin Therapy for LDL Reduction and CV Risk

Matthew J. Budoff, MD, comments on the role of statin therapy for dyslipidemia and shares considerations for appropriate selection and use.

Transcript

Deepak L. Bhatt, MD, MPH: I’m glad you brought in all that, because lifestyle modification is critically important. But there are multiple things that can be done. You mentioned some of the newer diabetes drugs—SGLT2 inhibitors, GLP1 receptor agonists—that have really made an enormous impact on reducing cardiovascular risk among people with diabetes, and the antithrombotics as well. I’m glad you mentioned it as well, because these are really complementary approaches to correcting dyslipidemia.

Speaking of correcting dyslipidemia, let’s say we’ve got a patient for whom we’re doing all the right things in terms of recommendations regarding lifestyle modification, weight reduction, exercise. We have the patient adhering to all those recommendations. Good blood pressure—lowering therapy is implemented, smoking cessation, good diabetes control, and so forth. What about dyslipidemia, specifically? Let me turn to Dr Budoff to discuss the role of statins in reducing that associated cardiovascular risk from elevated levels of LDL [low-density lipoprotein]. Describe what the mechanisms of action are. How do you pick between statins, dose, intensity, etc? Finally, comment on the potential adverse effects and concerns around those.

Matthew J. Budoff, MD: Thank you very much. I just want to reemphasize what Dr Anne Marie Navar touched on. We have to start with lifestyle and incorporate that. We’re often quick to prescribe a therapy without appropriate background treatment. Statins have obviously become our cornerstone of therapy for coronary artery disease prevention as well as secondary treatment. And really, statins have been demonstrated to work in almost every possible scenario.

Earlier, Dr Navar talked about all the different scenarios we could see—everything from primary prevention all the way up to acute coronary syndrome and even polyvascular disease, where more than 1 bed of vascular compromise is present. And really, statins have been proven across all those. Statins are potent event reducers. They lower LDL based on all different doses, but we really get anywhere from about an 18% LDL reduction all the way up to almost a 50% LDL reduction on average, going from the mildest of statins all the way to the highest doses of the most potent statins. So we can really effectively reduce LDL. And what we’ve seen in clinical trials is that LDL reduction parallels with event reduction. As we get larger numbers of LDL drop in our patients, we see larger reductions in cardiovascular risk.

Internal server error