Lowering LDL cholesterol: questions from recent meta-analyses and subset analyses of clinical trial DataIssues from the Interdisciplinary Council on Reducing the Risk for Coronary Heart Disease, ninth Council meeting.

Abstract:

:The benefit of cholesterol-lowering therapy in the prevention of coronary heart disease (CHD) is well established. The secondary prevention Scandinavian Simvastatin Survival Study (4S) and the primary prevention West of Scotland Coronary Prevention Study (WOSCOPS) demonstrated that lipid lowering with a statin can dramatically and cost-effectively reduce CHD morbidity and mortality with no increase in noncardiovascular mortality. The Cholesterol and Recurrent Events (CARE) trial extended benefit to CHD patients without high cholesterol. Post hoc analyses of data from these large trials are contributing to speculation, driven by subset analyses and meta-analyses, about whether cholesterol intervention should be target based, as current guidelines recommend. Whereas CARE data support the importance of baseline LDL cholesterol (LDL-C), with greatest clinical event risk reduction in the upper part of the LDL-C range in the trial, 4S found no difference in outcome according to baseline LDL-C in a quartile analysis, and WOSCOPS found no linear relation between decrease in LDL-C and decrease in relative risk for CHD. Furthermore, WOSCOPS showed no additional clinical benefit with LDL-C lowering beyond approximately 24%. Questions raised by such analyses require answers from prospective, hypothesis-based data, and at present there is no compelling argument for moving away from LDL-C targets. The hypothesis-based findings of 4S, CARE, and WOSCOPS support current clinical guidelines, and lowering LDL-C may reduce risk more substantially than might have been predicted.

journal_name

Circulation

journal_title

Circulation

authors

Gotto AM Jr,Grundy SM

doi

10.1161/01.cir.99.8.e1

subject

Has Abstract

pub_date

1999-03-02 00:00:00

pages

E1-7

issue

8

eissn

0009-7322

issn

1524-4539

journal_volume

99

pub_type

  • Prognostic value of pharmacological stress echocardiography is affected by concomitant antiischemic therapy at the time of testing.

    abstract:BACKGROUND:The aim of this study was to determine whether antianginal medications affect the prognostic value of pharmacological stress echocardiography. METHODS AND RESULTS:From the EPIC-EDIC Data Bank, 7333 patients (5452 men; age; 59+/-10 years) underwent pharmacological stress echocardiography with either high-dos...

    journal_title:Circulation

    pub_type: 杂志文章,多中心研究

    doi:10.1161/01.CIR.0000127427.03361.5E

    authors: Sicari R,Cortigiani L,Bigi R,Landi P,Raciti M,Picano E,Echo-Persantine International Cooperative (EPIC) Study Group.,Echo-Dobutamine International Cooperative (EDIC) Study Group.

    更新日期:2004-05-25 00:00:00

  • Does length or eccentricity of coronary stenoses influence the outcome of transluminal dilatation?

    abstract::In 526 patients undergoing a first percutaneous transluminal coronary angioplasty (PTCA) of a single native vessel, we studied the influence of length and eccentricity of the lesion on complications and primary success. Long stenoses (greater than or equal to 5 mm, n = 153) did not differ from short stenoses (less tha...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.67.3.497

    authors: Meier B,Gruentzig AR,Hollman J,Ischinger T,Bradford JM

    更新日期:1983-03-01 00:00:00

  • Residual Inflammatory Risk on Treatment With PCSK9 Inhibition and Statin Therapy.

    abstract:BACKGROUND:The combination of statin therapy and PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibition markedly lowers low-density lipoprotein cholesterol (LDL-C) and reduces cardiovascular event rates. Whether residual inflammatory risk as measured by on-treatment high sensitivity C-reactive protein (hsCRP)...

    journal_title:Circulation

    pub_type: 杂志文章,随机对照试验

    doi:10.1161/CIRCULATIONAHA.118.034645

    authors: Pradhan AD,Aday AW,Rose LM,Ridker PM

    更新日期:2018-07-10 00:00:00

  • Enhancement of procainamide-induced rate-dependent conduction slowing by elevated myocardial extracellular potassium concentration in vivo.

    abstract::Procainamide, a type 1A antiarrhythmic drug, blocks sodium channels and reduces the maximum rate of rise of the cardiac action potential (Vmax) in a rate-dependent fashion. In vitro, the magnitude of this rate-dependent reduction in Vmax is greater in tissue that is partially depolarized at rest than in tissue with a ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.76.6.1380

    authors: Cascio WE,Foster JR,Buchanan JW Jr,Johnson TA,Gettes LS

    更新日期:1987-12-01 00:00:00

  • Cardiac interbeat interval dynamics from childhood to senescence : comparison of conventional and new measures based on fractals and chaos theory.

    abstract:BACKGROUND:New methods of R-R interval variability based on fractal scaling and nonlinear dynamics ("chaos theory") may give new insights into heart rate dynamics. The aims of this study were to (1) systematically characterize and quantify the effects of aging from early childhood to advanced age on 24-hour heart rate ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.100.4.393

    authors: Pikkujämsä SM,Mäkikallio TH,Sourander LB,Räihä IJ,Puukka P,Skyttä J,Peng CK,Goldberger AL,Huikuri HV

    更新日期:1999-07-27 00:00:00

  • Practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the Inte

    abstract::The goals of electrocardiographic (ECG) monitoring in hospital settings have expanded from simple heart rate and basic rhythm determination to the diagnosis of complex arrhythmias, myocardial ischemia, and prolonged QT interval. Whereas computerized arrhythmia analysis is automatic in cardiac monitoring systems, compu...

    journal_title:Circulation

    pub_type: 指南,杂志文章,实务指引

    doi:10.1161/01.CIR.0000145144.56673.59

    authors: Drew BJ,Califf RM,Funk M,Kaufman ES,Krucoff MW,Laks MM,Macfarlane PW,Sommargren C,Swiryn S,Van Hare GF,American Heart Association.,Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young.

    更新日期:2004-10-26 00:00:00

  • Long-term evolution and prognostic stratification of biopsy-proven active myocarditis.

    abstract:BACKGROUND:Active myocarditis is characterized by large heterogeneity of clinical presentation and evolution. This study describes the characteristics and the long-term evolution of a large sample of patients with biopsy-proven active myocarditis, looking for accessible and valid early predictors of long-term prognosis...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.113.003092

    authors: Anzini M,Merlo M,Sabbadini G,Barbati G,Finocchiaro G,Pinamonti B,Salvi A,Perkan A,Di Lenarda A,Bussani R,Bartunek J,Sinagra G

    更新日期:2013-11-26 00:00:00

  • Lipoprotein oxidation and progression of carotid atherosclerosis.

    abstract:BACKGROUND:Epidemiological studies and animal experiments have provided evidence supporting the role of lipid peroxidation in atherogenesis and cardiovascular diseases. Direct evidence linking lipid oxidation to atherosclerotic progression in humans, however, has been lacking. We investigated the association of lipid o...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.95.4.840

    authors: Salonen JT,Nyyssönen K,Salonen R,Porkkala-Sarataho E,Tuomainen TP,Diczfalusy U,Björkhem I

    更新日期:1997-02-18 00:00:00

  • Secondary prevention of stroke and transient ischemic attack: is more platelet inhibition the answer?

    abstract:BACKGROUND:Recurrent cerebrovascular events constitute an estimated 200,000 of the 700,000 strokes reported annually in the United States, which makes secondary stroke prevention an important goal in the management of disease among patients who have experienced stroke or transient ischemic attack. METHODS AND RESULTS:...

    journal_title:Circulation

    pub_type: 杂志文章,评审

    doi:10.1161/CIRCULATIONAHA.106.653741

    authors: Liao JK

    更新日期:2007-03-27 00:00:00

  • Selective upregulation of endothelin B receptor gene expression in severe pulmonary hypertension.

    abstract:BACKGROUND:The pulmonary circulation is an important site for the production and clearance of endothelin (ET)-1, a potent vasoactive and mitogenic peptide. Increased plasma ET-1 levels are observed in pulmonary arterial hypertension (PHT) and may contribute to the regulation of pulmonary vascular resistance, as well as...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章

    doi:10.1161/hc0902.105719

    authors: Bauer M,Wilkens H,Langer F,Schneider SO,Lausberg H,Schäfers HJ

    更新日期:2002-03-05 00:00:00

  • The Effect of Coconut Oil Consumption on Cardiovascular Risk Factors: A Systematic Review and Meta-Analysis of Clinical Trials.

    abstract:BACKGROUND:Coconut oil is high in saturated fat and may, therefore, raise serum cholesterol concentrations, but beneficial effects on other cardiovascular risk factors have also been suggested. Therefore, we conducted a systematic review of the effect of coconut oil consumption on blood lipids and other cardiovascular ...

    journal_title:Circulation

    pub_type: 杂志文章,meta分析

    doi:10.1161/CIRCULATIONAHA.119.043052

    authors: Neelakantan N,Seah JYH,van Dam RM

    更新日期:2020-03-10 00:00:00

  • Clearance of tissue plasminogen activator (TPA) and TPA/plasminogen activator inhibitor type 1 (PAI-1) complex: relationship to elevated TPA antigen in patients with high PAI-1 activity levels.

    abstract:BACKGROUND:To evaluate the effect of plasminogen activator inhibitor type 1 (PAI-1) levels on the clearance of total tissue plasminogen activator (TPA) antigen, we studied the clearance of active TPA and TPA/PAI-1 complex in subjects with low (181+/-109 pmol/L; n=7) and high (1166+/-322 pmol/L; n=4) baseline active PAI...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.96.3.761

    authors: Chandler WL,Alessi MC,Aillaud MF,Henderson P,Vague P,Juhan-Vague I

    更新日期:1997-08-05 00:00:00

  • Experience with bretylium tosylate by a hospital cardiac arrest team.

    abstract::The effect of bretylium tosylate (BT) was determined in 27 consecutive cases of resistant ventricular fibrillation (VF) encountered by a hospital cardiac arrest team. The VF was sustained and completely resistant to multiple injections of lidocaine, sequential DC shocks at 400 watt-sec and one or a combination of intr...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.55.3.541

    authors: Holder DA,Sniderman AD,Fraser G,Fallen EL

    更新日期:1977-03-01 00:00:00

  • Chymase inhibition prevents fibronectin and myofibrillar loss and improves cardiomyocyte function and LV torsion angle in dogs with isolated mitral regurgitation.

    abstract:BACKGROUND:The left ventricular (LV) dilatation of isolated mitral regurgitation (MR) is associated with an increase in chymase and a decrease in interstitial collagen and extracellular matrix. In addition to profibrotic effects, chymase has significant antifibrotic actions because it activates matrix metalloproteinase...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.109.921619

    authors: Pat B,Chen Y,Killingsworth C,Gladden JD,Shi K,Zheng J,Powell PC,Walcott G,Ahmed MI,Gupta H,Desai R,Wei CC,Hase N,Kobayashi T,Sabri A,Granzier H,Denney T,Tillson M,Dillon AR,Husain A,Dell'italia LJ

    更新日期:2010-10-12 00:00:00

  • Exercise training attenuates age-associated diastolic dysfunction in rats.

    abstract:BACKGROUND:In contrast to systolic function, which is relatively well preserved with advancing age, diastolic function declines steadily after age 30. Our goal was to determine whether changes in diastolic function that occur with aging could be reversed with exercise training. Methods and Results-- Adult (6-month-old)...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.104.2.221

    authors: Brenner DA,Apstein CS,Saupe KW

    更新日期:2001-07-10 00:00:00

  • Clinical relevance of C-reactive protein during follow-up of patients with acute coronary syndromes in the Aggrastat-to-Zocor Trial.

    abstract:BACKGROUND:Elevated levels of high-sensitivity C-reactive protein (hsCRP) are associated with higher risk of adverse outcomes in patients at risk for or with established coronary artery disease. Retrospective analyses suggest that this risk may be modified with statin therapy. However, a role for hsCRP in monitoring th...

    journal_title:Circulation

    pub_type: 杂志文章,随机对照试验

    doi:10.1161/CIRCULATIONAHA.106.628909

    authors: Morrow DA,de Lemos JA,Sabatine MS,Wiviott SD,Blazing MA,Shui A,Rifai N,Califf RM,Braunwald E

    更新日期:2006-07-25 00:00:00

  • Human monocyte-endothelial cell interaction induces synthesis of granulocyte-macrophage colony-stimulating factor.

    abstract:BACKGROUND:Adhesion of monocytes to the endothelium is an initial step in the early stages of atherosclerosis and inflammation. Granulocyte-macrophage colony-stimulating factor (GM-CSF) stimulates a range of functional activities of monocytes, including regulation of monocyte adhesion and induction of cytokine producti...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.93.6.1185

    authors: Takahashi M,Kitagawa S,Masuyama JI,Ikeda U,Kasahara T,Takahashi YI,Furukawa Y,Kano S,Shimada K

    更新日期:1996-03-15 00:00:00

  • Hyperlipidemia and coronary disease. Correction of the increased thrombogenic potential with cholesterol reduction.

    abstract:BACKGROUND:Hypercholesterolemia is a risk factor for coronary disease, and platelet reactivity is increased with hypercholesterolemia, suggesting a prethrombotic risk. The aim of this study was to measure mural platelet thrombus formation on an injured arterial wall in a model simulating vessel stenosis and plaque rupt...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.92.11.3172

    authors: Lacoste L,Lam JY,Hung J,Letchacovski G,Solymoss CB,Waters D

    更新日期:1995-12-01 00:00:00

  • Vascular signal transducer and activator of transcription-3 promotes angiogenesis and neuroplasticity long-term after stroke.

    abstract:BACKGROUND:Poststroke angiogenesis contributes to long-term recovery after stroke. Signal transducer and activator of transcription-3 (Stat3) is a key regulator for various inflammatory signals and angiogenesis. It was the aim of this study to determine its function in poststroke outcome. METHODS AND RESULTS:We genera...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.114.013003

    authors: Hoffmann CJ,Harms U,Rex A,Szulzewsky F,Wolf SA,Grittner U,Lättig-Tünnemann G,Sendtner M,Kettenmann H,Dirnagl U,Endres M,Harms C

    更新日期:2015-05-19 00:00:00

  • Thioredoxin-2 inhibits mitochondrial reactive oxygen species generation and apoptosis stress kinase-1 activity to maintain cardiac function.

    abstract:BACKGROUND:Thioredoxin 2 (Trx2) is a key mitochondrial protein that regulates cellular redox and survival by suppressing mitochondrial reactive oxygen species generation and by inhibiting apoptosis stress kinase-1 (ASK1)-dependent apoptotic signaling. To date, the role of the mitochondrial Trx2 system in heart failure ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.114.012725

    authors: Huang Q,Zhou HJ,Zhang H,Huang Y,Hinojosa-Kirschenbaum F,Fan P,Yao L,Belardinelli L,Tellides G,Giordano FJ,Budas GR,Min W

    更新日期:2015-03-24 00:00:00

  • Neuraxial modulation for refractory ventricular arrhythmias: value of thoracic epidural anesthesia and surgical left cardiac sympathetic denervation.

    abstract:BACKGROUND:Reducing sympathetic output to the heart from the neuraxis can protect against ventricular arrhythmias. The purpose of this study was to assess the value of thoracic epidural anesthesia (TEA) and left cardiac sympathetic denervation (LCSD) in the management of ventricular arrhythmias in patients with structu...

    journal_title:Circulation

    pub_type: 杂志文章,多中心研究

    doi:10.1161/CIRCULATIONAHA.109.929703

    authors: Bourke T,Vaseghi M,Michowitz Y,Sankhla V,Shah M,Swapna N,Boyle NG,Mahajan A,Narasimhan C,Lokhandwala Y,Shivkumar K

    更新日期:2010-06-01 00:00:00

  • Evolving strategies for treatment of acute aortic dissection type A.

    abstract:OBJECTIVE:To assess the outcome of 3 different surgical approaches for treatment of acute aortic dissection type A (AADA). METHODS AND RESULTS:Between October 1990 and October 2003, we operated on 295 patients (pts) for AADA. Follow-up was complete for 257 pts (87%). Supracommissural replacement (SCR) of the ascending...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.CIR.0000138948.14144.d6

    authors: Kallenbach K,Oelze T,Salcher R,Hagl C,Karck M,Leyh RG,Haverich A

    更新日期:2004-09-14 00:00:00

  • The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissue-type plasminogen activator and streptokinase from the Thrombolysis in Myocardial Infarction (TIMI Phase I) trial.

    abstract::In Phase I of the NHLBI trial of Thrombolysis in Myocardial Infarction (TIMI), 290 patients admitted within 7 hr after onset of acute infarction were randomly assigned to intravenous treatment with either streptokinase (SK) or recombinant tissue-type plasminogen activator (rt-PA). Left ventricular function was measure...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.cir.75.4.817

    authors: Sheehan FH,Braunwald E,Canner P,Dodge HT,Gore J,Van Natta P,Passamani ER,Williams DO,Zaret B

    更新日期:1987-04-01 00:00:00

  • Regulation of bone morphogenetic protein-2 expression in endothelial cells: role of nuclear factor-kappaB activation by tumor necrosis factor-alpha, H2O2, and high intravascular pressure.

    abstract:BACKGROUND:Recent studies suggest that bone morphogenetic protein-2 (BMP-2), a transforming growth factor-beta superfamily member cytokine, plays an important role both in vascular development and pathophysiological processes, including endothelial activation that is likely to contribute to the development of coronary ...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.CIR.0000164201.40634.1D

    authors: Csiszar A,Smith KE,Koller A,Kaley G,Edwards JG,Ungvari Z

    更新日期:2005-05-10 00:00:00

  • Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation: a prospective randomized study comparing circumferential pulmonary vein ablation with a modified approach.

    abstract:BACKGROUND:Circumferential pulmonary vein ablation (CPVA) is effective in curing atrial fibrillation (AF), but new-onset left atrial tachycardia (AT) is a potential complication. We evaluated whether a modified CPVA approach including additional ablation lines on posterior wall and the mitral isthmus would reduce the i...

    journal_title:Circulation

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1161/01.CIR.0000147186.83715.95

    authors: Pappone C,Manguso F,Vicedomini G,Gugliotta F,Santinelli O,Ferro A,Gulletta S,Sala S,Sora N,Paglino G,Augello G,Agricola E,Zangrillo A,Alfieri O,Santinelli V

    更新日期:2004-11-09 00:00:00

  • Impact of partner bereavement on quality of cardiovascular disease management.

    abstract:BACKGROUND:Bereavement is a period of increased risk of cardiovascular death. There is limited understanding of the potential contribution of quality of cardiovascular disease management to this increased risk. METHODS AND RESULTS:In a UK primary-care database, 12 722 older individuals with preexisting cardiovascular ...

    journal_title:Circulation

    pub_type: 杂志文章,多中心研究

    doi:10.1161/CIRCULATIONAHA.113.004122

    authors: Shah SM,Carey IM,Harris T,Dewilde S,Victor CR,Cook DG

    更新日期:2013-12-24 00:00:00

  • Body fat distribution and risk of coronary heart disease in men and women in the European Prospective Investigation Into Cancer and Nutrition in Norfolk cohort: a population-based prospective study.

    abstract:BACKGROUND:Body fat distribution has been cross-sectionally associated with atherosclerotic disease risk factors, but the prospective relation with coronary heart disease remains uncertain. METHODS AND RESULTS:We examined the prospective relation between fat distribution indices and coronary heart disease among 24,508...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.106.673756

    authors: Canoy D,Boekholdt SM,Wareham N,Luben R,Welch A,Bingham S,Buchan I,Day N,Khaw KT

    更新日期:2007-12-18 00:00:00

  • Interlesion dependence of the risk for restenosis in patients with coronary stent placement in in multiple lesions.

    abstract:BACKGROUND:Little is known about the behavior with regard to restenosis of multiple lesions within the same patient treated with intracoronary stenting. Our objective was to test the hypothesis that there is an intrapatient dependence of restenosis between lesions. METHODS AND RESULTS:Quantitative analysis was carried...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.97.24.2396

    authors: Kastrati A,Schömig A,Elezi S,Schühlen H,Wilhelm M,Dirschinger J

    更新日期:1998-06-23 00:00:00

  • Transvenous coronary ultrasound imaging. A novel approach to visualization of the coronary arteries.

    abstract:BACKGROUND:Catheter-based ultrasound is a new imaging modality to examine endovascular detail in the coronary circulation. This technique requires direct placement of the catheter in the arterial segment of interest. METHODS AND RESULTS:We examined the feasibility of a less invasive approach by imaging the coronary ar...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/01.cir.84.5.1957

    authors: Sudhir K,Fitzgerald PJ,MacGregor JS,DeMarco T,Ports TA,Chatterjee K,Yock PG

    更新日期:1991-11-01 00:00:00

  • Lack of association between the MEF2A gene and myocardial infarction.

    abstract:BACKGROUND:Coronary artery disease (CAD) and myocardial infarction (MI) are caused in part by genetic factors. Recently, the MEF2A gene was linked to MI/CAD in a single pedigree with autosomal-dominant pattern of inheritance. In addition, genetic variants within the gene have been associated with MI in case-control set...

    journal_title:Circulation

    pub_type: 杂志文章

    doi:10.1161/CIRCULATIONAHA.107.728485

    authors: Lieb W,Mayer B,König IR,Borwitzky I,Götz A,Kain S,Hengstenberg C,Linsel-Nitschke P,Fischer M,Döring A,Wichmann HE,Meitinger T,Kreutz R,Ziegler A,Schunkert H,Erdmann J

    更新日期:2008-01-15 00:00:00