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Statin Treatment in Specific Patient Groups: Role for Improved Cardiovascular Risk Markers

1
Department of Pharmaceutical Sciences and Administration, University of New England, Portland, ME 04103, USA
2
Department of Pharmacy Practice, School of Pharmacy, University of New England, Portland, ME 04103, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(11), 3748; https://doi.org/10.3390/jcm9113748
Received: 9 October 2020 / Revised: 17 November 2020 / Accepted: 18 November 2020 / Published: 21 November 2020
Ample evidence supports the use of statin therapy for secondary prevention in patients with a history of atherosclerotic cardiovascular disease (ASCVD), but evidence is wanting in the case of primary prevention, low-risk individuals, and elderly adults 65+. Statins are effective in lowering low-density lipoprotein (LDL), which has long been a target for treatment decisions. We discuss the weakening dependence between cholesterol levels and mortality as a function of age and highlight recent findings on lipoprotein subfractions and other superior markers of ASCVD risk. The efficacy of statins is compared for distinct subsets of patients based on age, diabetes, ASCVD, and coronary artery calcium (CAC) status. Most cardiovascular risk calculators heavily weight age and overestimate one’s absolute risk of ASCVD, particularly in very old adults. Improvements in risk assessment enable the identification of specific patient populations that benefit most from statin treatment. Derisking is particularly important for adults over 75, in whom treatment benefits are reduced and adverse musculoskeletal effects are amplified. The CAC score stratifies the benefit effect size obtainable with statins, and forms of coenzyme Q are discussed for improving patient outcomes. Robust risk estimator tools and personalized, evidence-based approaches are needed to optimally reduce cardiovascular events and mortality rates through administration of cholesterol-lowering medications. View Full-Text
Keywords: cardiovascular disease; statins; primary prevention; geriatrics; risk biomarkers; cardiovascular risk calculators; low-density lipoprotein cholesterol; lipoprotein subfractions; coronary artery calcification; coenzyme Q cardiovascular disease; statins; primary prevention; geriatrics; risk biomarkers; cardiovascular risk calculators; low-density lipoprotein cholesterol; lipoprotein subfractions; coronary artery calcification; coenzyme Q
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MDPI and ACS Style

White, A.M.B.; Mishcon, H.R.; Redwanski, J.L.; Hills, R.D., Jr. Statin Treatment in Specific Patient Groups: Role for Improved Cardiovascular Risk Markers. J. Clin. Med. 2020, 9, 3748. https://doi.org/10.3390/jcm9113748

AMA Style

White AMB, Mishcon HR, Redwanski JL, Hills RD Jr.. Statin Treatment in Specific Patient Groups: Role for Improved Cardiovascular Risk Markers. Journal of Clinical Medicine. 2020; 9(11):3748. https://doi.org/10.3390/jcm9113748

Chicago/Turabian Style

White, Alyssa M.B.; Mishcon, Hillary R.; Redwanski, John L.; Hills, Ronald D., Jr. 2020. "Statin Treatment in Specific Patient Groups: Role for Improved Cardiovascular Risk Markers" J. Clin. Med. 9, no. 11: 3748. https://doi.org/10.3390/jcm9113748

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