The Medical Letter on Drugs and Therapeutics
When a Statin Fails
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Revised 8/5/09: The first paragraph should have included the words "for patients at high risk" after 100 mg/dL (2.6 mmol/L).

The National Cholesterol Education Program recommends that LDL-C be lowered to less than 100 mg/dL (2.6 mmol/L) for patients at high risk and considers a value <70 mg/dL (1.8 mmol/L) a reasonable goal for patients at very high risk.

LDL-C TARGETS —A meta-analysis of 58 placebo-controlled, lipid-lowering trials showed that statins reduced ischemic heart disease events by 20%, 31% and 51% when mean reductions of LDL-C were 20 mg/dL (0.5 mmol/L), 40 mg/dL (1.0 mmol/L) and 62 mg/dL (1.6 mmol/L) respectively, and reduced strokes by 10% and 17% when LDL-C was lowered by 40 mg/dL (1.0 mmol/L) and 70 mg/dL (1.8 mmol/L) respectively.1 In a controlled trial, 2 years of treatment with 40 mg of rosuvastatin (Crestor) reduced LDL-C by 53% to 61 mg/dL and led to significant regression of coronary atherosclerosis.2


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