"Ju lägre LDL-kolesterol, desto bättre" gäller fortsatt. Negativa/neutrala slutsatser av tre statinstudier ändrar inte klinisk praxis
Engelsk titel: "The lower LDL cholesterol levels, the better" still valid. Negative/neutral conclusions of three studies on statins do not change the clinical practice
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Författare:
Olsson A
;
Nilsson PM
Email: andol@imv.liu.se
Språk: Swe
Antal referenser: 22
Dokumenttyp:
Översikt
UI-nummer: 09031361
Sammanfattning
Recently three large lipid studies have been published, ILLUMINATE with marked increase of HDL cholesterol through CETP inhibition and ENHANCE together with SEAS with more LDL cholesterol lowering than achieved by statin through inhibition of cholesterol absorption The first study had a negative outcome on clinical endpoints while the latter two had a neutral outcome on intima-media thickness in patients with heterozygous familial hypercholesterolaemia, and end-points associated with aortic stenosis, respectively. In the SEAS study more patients developed cancer on simvastatin + ezetimibe than on placebo. Plausible explanation to the outcomes are unpredicted off-target effects of the CETP inhibitor torcetrapib in ILLUMINATE and a patient population with to healthy carotid arteries in ENHANCE study. Further studies should be undertaken to document the possible clinical benefits of CETP inhibition and of inhibition of cholesterol absorption. Ezetimibe should be prescribed with caution until efficacy and safety has been proven in large scale intervention studies.