Cholesterol-lowering treatment in angina/MI

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

Reference:

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