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Cholesterol lowering with statins reduces the risk of vascular disease, but uncertainty remains as to whether more intensive statin therapy produces worthwhile benefits safely.
Use of OTC statins by consumers needing more intensive statin therapy or facing the risk of potential drug drug interactions remains an area of concern but occurred infrequently in CUSTOM.
The authors concluded that "in summary, more intensive statin therapy is safe and well-tolerated.
Large meta-analyses of randomised controlled trials (RCTs) of statins have demonstrated increased risk of developing type 2 diabetes when statins are compared with placebo or standard care [ 1], and when more intensive statin treatment is compared with less intensive [ 2].
Ballantyne reviewed benefits of administration of statins in metabolic syndrome (10), pointing out that with the compelling evidence of statin benefit, an argument may be made favoring the more intensive statin treatment goals of LDL and non-HDL cholesterol 70 and 100 mg/dl, respectively, and apolipoprotein B 80 mg/dl.
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These results are further corroborated by a meta-analysis carried out by the Cholesterol Treatment Trialist's Collaboration, in which more versus less intensive statin therapy was associated with a highly significant 15%9595% CI = 11 to 18; P <0.0001) further reduction in major vascular events [ 6].
Significant LDL-C reductions have been observed with more intensive therapy using higher doses of statins, but not all patients tolerate high-dose statins [ 11].
Recent statin trials have also demonstrated the early and improved clinical benefit of lowering LDL-C beyond traditional goals with intensive statin therapy vs more moderate lipid-lowering therapy.
Another example of disease prevention comes from the more intensive versus less intensive therapy with statins for secondary reduction of cardiovascular events and stroke.
At least for the use of statins, higher doses, more intensive LDL-cholesterol lowering, and improved vascular outcome appear to go hand in hand.
UK and Australian teams compared a standard statin treatment with a more intensive therapy, publishing results in the Lancet medical journal.
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