Fabiana Rached1, Raul D Santos2,3. 1. Heart Institute-InCor, University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil. 2. Heart Institute-InCor, University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil. rauldsf@gmail.com. 3. Hospital Israelita Albert Einstein, Av. Dr. Enéas C. Aguiar 44, CEP, São Paulo, 05403-900, Brazil. rauldsf@gmail.com.
Abstract
PURPOSE OF REVIEW: The causal association of LDL-cholesterol (LDL-C) with atherosclerotic cardiovascular disease (ASCVD) has been demonstrated in robust experimental, epidemiological, genetic, and interventional randomized controlled trials (RCTs). The goal of this review is to show how the knowledge acquired from statin RCTs influenced and was recommended on guidelines for prevention of ASCVD during the last three decades. RECENT FINDINGS: Guideline recommendations have evolved with accruing information derived mostly from statin RCTs, and as decades passed, more intensive LDL-C lowering was recommended according to a given ASCVD risk. Recent guidelines are unanimous in recommending intensive LDL-C lowering for the highest-risk individuals; however, they differ regarding risk stratification tools, use of specific LDL-C targets, management of primary prevention individuals, and thresholds to start non-statin lipid-lowering therapies. Even considering the advent of non-statin therapies like ezetimibe and PCSK9 inhibitors, due to their efficacy, safety, and low cost, guidelines state that statins persist as the main component of ASCVD preventive strategies and should be prescribed in adequate doses to attain evidence-based LDL-C lowering.
PURPOSE OF REVIEW: The causal association of LDL-cholesterol (LDL-C) with atherosclerotic cardiovascular disease (ASCVD) has been demonstrated in robust experimental, epidemiological, genetic, and interventional randomized controlled trials (RCTs). The goal of this review is to show how the knowledge acquired from statin RCTs influenced and was recommended on guidelines for prevention of ASCVD during the last three decades. RECENT FINDINGS: Guideline recommendations have evolved with accruing information derived mostly from statin RCTs, and as decades passed, more intensive LDL-C lowering was recommended according to a given ASCVD risk. Recent guidelines are unanimous in recommending intensive LDL-C lowering for the highest-risk individuals; however, they differ regarding risk stratification tools, use of specific LDL-C targets, management of primary prevention individuals, and thresholds to start non-statin lipid-lowering therapies. Even considering the advent of non-statin therapies like ezetimibe and PCSK9 inhibitors, due to their efficacy, safety, and low cost, guidelines state that statins persist as the main component of ASCVD preventive strategies and should be prescribed in adequate doses to attain evidence-based LDL-C lowering.