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Figure
5. Panel A
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In the CARE trial, one-third of patients were treated to an LDL-C level below 125 mg/dL (panel A). In the ALLHAT trial, patients in the �usual care� group lowered their LDL-C level below 130 mg/dL, while the group treated with pravastatin achieved an LDL-C near 100 mg/dL (panel B). Both the CARE (panel A) and ALLHAT (panel C) trials suggest that lowering LDL-C below 130 mg/dL with a statin would be expected to produce little, if any, benefit. For patients with no previous CHD, the WOSCOPS study showed that lowering LDL-C more than 20% produced no additional benefit (panel D). The AVERT study used the highest dose of our most potent statin, and showed only a marginal benefit despite driving LDL-C levels below 100 mg/dL (panel E). These data suggest that after LDL-C has been lowered below 130 mg/dL with a statin, combination therapy with a fibrate or niacin might be required to achieve more event reduction. |
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