November 30, 2023

Primary prevention is the term used when a patient with elevated bad cholesterol (low-density cholesterol or LDL-C) and other risk factors is treated to prevent heart attack, stroke, and other diseases related to accumulation of fat in blood vessels (cardiovascular diseases). Secondary prevention is when patient known to have cardiovascular disease is treated to prevent recurrence of symptoms or progression of the disease.
Several studies have already shown that treatment or lowering of bad cholesterol levels even among persons without cardiovascular disease has led to decrease in heart attack, stroke, and death rates. Treatment is considered when the LDL-C is greater than 100 mg/dl (2.59 mmol/L) and has risk factors, and treatment is started when the LDL-C level is greater than 160 mg/dl.
Statins are the drugs recommended, and if the drug does not have side effects or if it does not cause a heavy financial burden on an individual, it is offered as treatment to all persons who are at risk of developing complications in the same way that diet and exercise are advised.
Statins decrease cardiovascular risk by about 20 to 30 percent. When the decision to start treatment to prevent heart attack or stroke is made, moderate dose of statin is recommended by some experts like 20mg Atorvastatin, 5 to 10mg of Rosuvastatin, instead of starting at higher doses Patients who are considered to be at very high risk are treated with higher doses. Response to treatment is measured after six weeks then every 12 months thereafter.
If a patient treated for primary prevention develops adverse reaction to statin, lifestyle modification and anti-platelet therapy are given.
Statins are not to be used by pregnant women. Some experts in management of cholesterol abnormalities do not recommend use of statins in persons older than 85 years, patients with life expectancy less than five years.
Side effects of statins include muscle and liver injury. Use of the drug should thus be under the supervision of a physician since dose adjustments or cessation of use may be done when necessary, and other existing illnesses are considered. In patients with severe kidney dysfunction, the dose has to be reduced.

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