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Endothelial dysfunction
From first decade From third decade From fourth decade
Smooth muscle Thrombosis,
Growth mainly by lipid accumulation and collagen haematoma
Risk
Obesity factors Smoking
Physical
Diabetes
inactivity
With elevation of
Clinical ASCVD
LDL-C ≥190 mg/dL
RRR
25 95% CI,
5 to 26%
20 (p=0.005)
(%)
15 ARR 3.9%
NNT 26
over 2 years
10
Pravastatin 40 mg (n=2063). Median LDL-C 95 mg/dL
5 Atorvastatin 80 mg (n=2099). Median LDL-C 62 mg/dL
5
ARR 1.2% NNT=83 over 30 days RRR
4
for ACS (%)
HR 0.72
3 95% CI,
0.52 to 0.99
(p=0.046)
2
0
0 5 10 15 20 25 30
Time (days following randomization)
Ray K, et al. JACC 2005;46:1405–1410
Reprinted from Journal of the American College of Cardiology, Volume 46, Ray K, et al. Early and Late Benefits of High-Dose Atorvastatin
in Patients With Acute Coronary Syndromes, 1405–1410. Copyright (2005), with permission from Elsevier
Statins eliminated by hepatic route are preferred →
Atorvastatin is the only high-intensity statin eliminated by
hepatic route
Summary
• Acknowledgement of ASCVD risk factors may be helpful in preventing CVD
– The first step in this process is the calculation of individual cardiovascular risk
according to risk factor exposure
• The new lipid guideline is moving beyond LDL-C target to ASCVD risk
reduction and recommends
– High-intensive statin treatment is recommended in patients wit ACS and coronary
heart disease
• Safety aspect needs to be considered when choosing moderate to high
intensity statin treatment, especially in special patients population such as
ACS and CKD patients
• Recent clinical trials suggest that atorvastatin shows a significant renal
safety profile