Tony
EBM has prescribing budgets by the short and curlies on this one.
Most tested drug in endpoint (ie death / MI) primary prevention studies
=pravastatin
ONLY tested pravastatin dose = 40mg daily
Lipid lowering effect approx 25-30% total LDL converts to 30% reduction
in events (very roughly)
ONLY OTHER statin in events based big study = simvastatin
dose titration 10-40mg to get total chol <5.2
Lipid lowering effect approx 25-30% total LDL converts to 30% reduction
in events (very roughly)
BUT only in post MI with total chol at entry above ?6.2?? and TG <?3??
whereas pravastatin trials used lower entry cholesterols and higher
accepted TGs do wider range of patients.
Plaque stabilisation probably does matter. Soft, often small, lipid &
macrophage-rich plaques are the ones that rupture causing MI / unstable
angina. Statins affect macrophage function (particularly in response to
oxidated LDL) so probably do act to stabilise plaque (they also improve
endothelial function apparently. There is evidence that simva, fluva
and prava all have effects on plaque stability.
Caveat: this probably isn't bollocks but it might be - I'm not a
lipidologist. However point your browser at medline and "plaque +
stability + lipid" and unfold the story for yourself ....
Chris
Dr Chris Burton
Sanquhar Health Centre
Dumfriesshire DG4 6BT
(01659) 50221
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