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      Racial Differences in the Cholesterol-Lowering Effect of Statin

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          Abstract

          Statin treatment to reduce low-density lipoprotein cholesterol (LDL-C) is associated with the prevention of cardiovascular events in Western patients. Similar results have been reported in studies conducted in Japan. However, the dose of statins and the degree of LDL-C reduction achieved with statins are different between Asian and Western patients. In addition, there are limited data regarding racial differences in response to statins. In this review, racial differences between Asians and Westerners in response to statins are described.

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          2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

          Neil J Stone, Jennifer G Robinson, Alice H. Lichtenstein … (2014)
          Supplemental Digital Content is available in the text.
          Article 0 comments Cited 1008 times – based on 0 reviews     Review now
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            Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S)

            A.G. Olsson, J McMurray, G Thorgeirsson … (1994)
            Drug therapy for hypercholesterolaemia has remained controversial mainly because of insufficient clinical trial evidence for improved survival. The present trial was designed to evaluate the effect of cholesterol lowering with simvastatin on mortality and morbidity in patients with coronary heart disease (CHD). 4444 patients with angina pectoris or previous myocardial infarction and serum cholesterol 5.5-8.0 mmol/L on a lipid-lowering diet were randomised to double-blind treatment with simvastatin or placebo. Over the 5.4 years median follow-up period, simvastatin produced mean changes in total cholesterol, low-density-lipoprotein cholesterol, and high-density-lipoprotein cholesterol of -25%, -35%, and +8%, respectively, with few adverse effects. 256 patients (12%) in the placebo group died, compared with 182 (8%) in the simvastatin group. The relative risk of death in the simvastatin group was 0.70 (95% CI 0.58-0.85, p = 0.0003). The 6-year probabilities of survival in the placebo and simvastatin groups were 87.6% and 91.3%, respectively. There were 189 coronary deaths in the placebo group and 111 in the simvastatin group (relative risk 0.58, 95% CI 0.46-0.73), while noncardiovascular causes accounted for 49 and 46 deaths, respectively. 622 patients (28%) in the placebo group and 431 (19%) in the simvastatin group had one or more major coronary events. The relative risk was 0.66 (95% CI 0.59-0.75, p < 0.00001), and the respective probabilities of escaping such events were 70.5% and 79.6%. This risk was also significantly reduced in subgroups consisting of women and patients of both sexes aged 60 or more. Other benefits of treatment included a 37% reduction (p < 0.00001) in the risk of undergoing myocardial revascularisation procedures. This study shows that long-term treatment with simvastatin is safe and improves survival in CHD patients.
            Article 0 comments Cited 524 times – based on 0 reviews     Review now
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              Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial.

              G G Schwartz, A Olsson, M Ezekowitz … (2001)
              Patients experience the highest rate of death and recurrent ischemic events during the early period after an acute coronary syndrome, but it is not known whether early initiation of treatment with a statin can reduce the occurrence of these early events. To determine whether treatment with atorvastatin, 80 mg/d, initiated 24 to 96 hours after an acute coronary syndrome, reduces death and nonfatal ischemic events. A randomized, double-blind trial conducted from May 1997 to September 1999, with follow-up through 16 weeks at 122 clinical centers in Europe, North America, South Africa, and Australasia. A total of 3086 adults aged 18 years or older with unstable angina or non-Q-wave acute myocardial infarction. Patients were stratified by center and randomly assigned to receive treatment with atorvastatin (80 mg/d) or matching placebo between 24 and 96 hours after hospital admission. Primary end point event defined as death, nonfatal acute myocardial infarction, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischemia with objective evidence and requiring emergency rehospitalization. A primary end point event occurred in 228 patients (14.8%) in the atorvastatin group and 269 patients (17.4%) in the placebo group (relative risk [RR], 0.84; 95% confidence interval [CI], 0.70-1.00; P =.048). There were no significant differences in risk of death, nonfatal myocardial infarction, or cardiac arrest between the atorvastatin group and the placebo group, although the atorvastatin group had a lower risk of symptomatic ischemia with objective evidence and requiring emergency rehospitalization (6.2% vs 8.4%; RR, 0.74; 95% CI, 0.57-0.95; P =.02). Likewise, there were no significant differences between the atorvastatin group and the placebo group in the incidence of secondary outcomes of coronary revascularization procedures, worsening heart failure, or worsening angina, although there were fewer strokes in the atorvastatin group than in the placebo group (12 vs 24 events; P =.045). In the atorvastatin group, mean low-density lipoprotein cholesterol level declined from 124 mg/dL (3.2 mmol/L) to 72 mg/dL (1.9 mmol/L). Abnormal liver transaminases (>3 times upper limit of normal) were more common in the atorvastatin group than in the placebo group (2.5% vs 0.6%; P<.001). For patients with acute coronary syndrome, lipid-lowering therapy with atorvastatin, 80 mg/d, reduces recurrent ischemic events in the first 16 weeks, mostly recurrent symptomatic ischemia requiring rehospitalization.
              Article 0 comments Cited 200 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Atheroscler Thromb
                Journal ID (iso-abbrev): J. Atheroscler. Thromb
                Journal ID (publisher-id): jat
                Journal ID (hwp): jat
                Title: Journal of Atherosclerosis and Thrombosis
                Publisher: Japan Atherosclerosis Society
                ISSN (Print): 1340-3478
                ISSN (Electronic): 1880-3873
                Publication date (Print): 1 January 2017
                Volume: 24
                Issue: 1
                Pages: 19-25
                Affiliations
                [1 ]Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
                [2 ]Department of Cardiology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
                Author notes
                Address for correspondence: Katsumi Miyauchi, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan E-mail: ktmmy@ 123456juntendo.ac.jp
                Article
                DOI: 10.5551/jat.RV16004
                PMC ID: 5225129
                PubMed ID: 27733728
                SO-VID: ddf49b5d-7148-4c00-a871-4d9f8575fdee
                Copyright © 2017 Japan Atherosclerosis Society
                License:

                This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

                History
                Date received : 26 July 2016
                Date accepted : 25 August 2016
                Page count
                Figures: 0, Tables: 4, References: 43, Pages: 7
                Categories
                Subject: Review

                Keywords: statin,racial differences,asian,westerner
                Data availability:
                Keywords: statin, racial differences, asian, westerner

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