M2. History of Cardiovascular Diseas or Dibetes and LDL-C Above Goal ?

objective

Identify patients who may benefit from lipid lowering therapy.

background

Secondary prevention refers to patients with known atherosclerotic cardiovascular disease (CVD).  It is an inclusive term for coronary peripheral and cerebrovascular diseases.

recommendations

1. All patients with known CVD are considered high-risk and should be treated with aggressive lipid-lowering therapy to prevent acute vascular events.  These include, but are not limited to, acute myocardial infarction (AMI) or cerebrovascular accident (CVA).

discussion

Trials with a variety of agents have demonstrated that treatment of dyslipidemias improves low density lipoprotein-cholesterol (LDL-C) and/or high density lipoprotein–cholesterol (HDL-C) profiles, and in addition, reduces coronary events (4S, 1994; CARE, 1996; LIPID, 1998; VA-HIT, 1999; LIPS, 2002; PROVE-IT, 2004; HPS, 2002), angiographic progression (CLAS, 1987; FATS, 1990; REVERSAL, 2004; LIPS, 2002), and CHD mortality along with total mortality (Oslo, 1986; Oslo, 1995; 4S, 1994; LIPID, 1998; FLARE, 1999).  Meta-analysis and subgroup analysis from coronary heart disease (CHD) trials have shown that statins or niacin reduce the incidence of stroke.  In the Heart Protection Study (HPS), the reduction in stroke was highly statistically significant for simvastatin (HPS, 2002).  A Cochrane review found that cholesterol-lowering therapy reduces progression of peripheral vascular disease (Leng et al., 2000).