Primary prevention of CVD: treating dyslipidaemia
INTRODUCTION: The incidence of dyslipidaemia is high: in 2000, approximately 25% of adults in the USA had total cholesterol greater than 6.2 mmol/L or were taking lipid-lowering medication. Primary prevention in this context is defined as long-term management of people at increased risk but with no clinically overt evidence of CVD — such as acute MI, angina, stroke, and PVD — and who have not undergone revascularisation. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of pharmacological cholesterol-lowering interventions in people at low risk (less than 0.6% annual CHD risk); at medium risk (0.6–1.4% annual CHD risk); and at high risk (at least 1.5% annual CHD risk)? What are the effects of reduced or modified fat diet? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: ezetimibe, fibrates, niacin (nicotinic acid), reduced- or modified-fat diet, resins, and statins.
Fodor G. Primary prevention of CVD: treating dyslipidaemia. Clinical Evidence 2010; 12:215.
Substantive changes at this update
Ezetimibe in people at low risk New option for which we identified no systematic review or RCTs in people at low risk of CHD events. Categorisation set at Unknown effectiveness.
Statins in people at low risk of CHD One further report of an already reported RCT analysed data in women alone. The RCT found no significant difference between pravastatin plus cholesterol-lowering diet and cholesterol-lowering diet alone in rate of CHD events at 5 years in women at low risk of CHD, although the rate was lower with addition of pravastatin. The RCT found that the reduction in rate of CHD associated with addition of pravastatin to a cholesterol-lowering diet was greater in older women (aged 60 years or older), but the difference between groups remained non-significant. Categorisation unchanged (Likely to be beneficial).
Ezetimibe in people at medium risk New option for which we identified no systematic review or RCTs in people at medium risk of CHD events. Categorisation set at Unknown effectiveness.
Resins in people at medium risk Existing evidence re-evaluated. Benefit of cholestyramine unclear; evidence presented in only men and may not be generalisable. Categorisation changed from Likely to be beneficial to Unknown effectiveness.
Ezetimibe in people at high risk New option for which we identified no systematic review or RCTs in people at high risk of CHD events. Categorisation set at Unknown effectiveness.
Statins in people at high risk of CHD A long-term follow-up report of one previously reported RCT in men with hypercholesterolaemia and no history of MI found that pravastatin reduced the composite outcome of non-fatal MI and fatal CHD at 15 years' follow-up. Categorisation unchanged (Beneficial).
Primary Prevention of Cardiovascular Disease and Type 2 Diabetes in Patients at Metabolic Risk: (01 October 2008)
The Endocrine Society
Rated by doctors in Relevance Newsworthiness General Practice(GP)/Family Practice(FP) **** *** General Internal Medicine-Primary Care(US) **** *** Hospital Doctor/Hospitalists ***** *** Internal Medicine ***** *** Cardiology ***** **** Endocrine ****** ******
Rated by doctors in Relevance Newsworthiness General Practice(GP)/Family Practice(FP) **** *** General Internal Medicine-Primary Care(US) **** *** Internal Medicine ****** ****** Endocrine ***** *****