Hypercholesterolaemia - secondary prevention

The landmark trials regarding the use of statins in secondary prevention are the 4S (Scandinavian Simvastatin Survival Study), the CARE (Cholesterol And Recurrent Events) trial and the LIPID (Long-term Intervention with Pravastatin in Ischaemic Heart Disease).

• these trials revealed that reduction of total serum cholesterol and low-density lipoprotein (LDL) cholesterol in the region of 25-35% using statin therapy led to a reduction in coronary heart disease (CHD) mortality by approximately the same degree
• the trial evidence was that patients with unstable angina benefited to the same degree as to those post - myocardial infarction

NICE suggest (1):

• start statin treatment in people with CVD with atorvastatin 80 mg. Use a lower dose of atorvastatin if any of the following apply:
  • potential drug interactions
  • high risk of adverse effects
  • patient preference
    
• Target
  • for secondary prevention of CVD, aim for low-density lipoprotein (LDL) cholesterol levels of 2.0 mmol per litre or less, or non-HDL cholesterol levels of 2.6 mmol per litre or less

Notes:

Reference:

• NICE (December 2023).Lipid modification - Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease