Personalize and Optimize Lipid-Lowering Therapies

IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) demonstrated that intensive lipid-lowering therapy with ezetimibe/simvastatin reduced first and subsequent cardiovascular events compared with placebo/simvastatin. An analysis of the 4S Study (Scandinavian Simvastatin Survival Study) revealed that inhibiting cholesterol synthesis with statins did not reduce cardiovascular endpoints in patients with high cholesterol absorption (1); instead, in this subset of patients, statins increased cardiovascular events. We reported previously that cholesterol homeostasis markers such as the ratio of campesterol to lathosterol were associated with coronary heart disease and were a strong predictor for cardiovascular risk (2). These findings were verified in the Framingham Study population, indicating that the ratio of campesterol to lathosterol is the best lipid parameter to predict cardiovascular risk.

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