One interesting phenomenon that I came across was that statins are not recommended for merely lowering lipid levels but for reducing atheromatous plaque disease. Although raised lipid levels are a risk factor but statins are given based on the risk stratification of the patient keeping in view the age, sex, smoking history, weight, prior cardiovascular event, diabetes and blood pressure. Infact there is a table for doing this risk stratification that we read during our medical school days. It is called the Farmingham table after the famous Farmingham study.
The recommended target levels for patients in whom statins are initiated varies from LDL-C <100mg/dl to <70mg/dl. There are documented ethnic differences in response to statins in african-americans. There is no such data available for the Asian lot. Most probably the reason being the unwillingness of commercial companies to further persue this route of enquiry.
Statins that are patented with multinationals are very expensive but almost equally efficacious to those that are free of this problem of patents. The price difference is almost 10 fold. This is remarkable for those who have to use these drugs for a very long term. Simvastatin is one such cheap drug. Lovastatin is another. Both drugs are available off patent. As an alternate strategy one can break a high dose formulation into smaller peices for daily use.
But lowering cholesterol is not the only approach towards preventing atheromatous plaque disease. This is just one step in many. The physicians must keep this in mind while treating patients.
Citation: Ong HT (2006) Evidence-based prescribing of statins: A developing world perspective. PLoS Med 3(3):e50.
The recommended target levels for patients in whom statins are initiated varies from LDL-C <100mg/dl to <70mg/dl. There are documented ethnic differences in response to statins in african-americans. There is no such data available for the Asian lot. Most probably the reason being the unwillingness of commercial companies to further persue this route of enquiry.
Statins that are patented with multinationals are very expensive but almost equally efficacious to those that are free of this problem of patents. The price difference is almost 10 fold. This is remarkable for those who have to use these drugs for a very long term. Simvastatin is one such cheap drug. Lovastatin is another. Both drugs are available off patent. As an alternate strategy one can break a high dose formulation into smaller peices for daily use.
But lowering cholesterol is not the only approach towards preventing atheromatous plaque disease. This is just one step in many. The physicians must keep this in mind while treating patients.
Citation: Ong HT (2006) Evidence-based prescribing of statins: A developing world perspective. PLoS Med 3(3):e50.
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