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Should everyone be to taking statins to reduce the risk of cardiovascular disease

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Introduction

Should everyone be to taking statins to reduce the risk of cardiovascular disease? Cardiovascular disease is one of the biggest killers of the modern world. Approximately 70,000 people die from cardiovascular disease or its complications every year in the UK alonei. Worldwide it claims over 17.1 million lives a yearii. Although CVD is a multi-factorial disease with many preventable and non-preventable causes, studies have shown that there is a high correlation between high LDL levels and the incidence of CVDiii. Statins are a group of drugs designed by the pharmatsuitical industry to reduce levels of LDL in one's blood. Low density lipoproteins are protein molecules made up of both triglycerides and cholesterol. Cholesterol is a sterol which means in it insoluble in water. In order for it to pass through the blood stream and diffuse through cell membranes it needs to be attached to a soluble chain molecule such as a triglyceride. Most cardio-vascular events start with the formation of an atheroma, which is an acculmation of fatty deposits in the artery walls between the inside of the artery (lumen) and the elastic muscle layer. An atheroma can lead to the narrow of the lumen in a process called stenosis which increases the patient's blood pressure. The blood constantly hitting the atheroma as it juts out into the lumen can cause it to harden. Often this leads to a disease called atherosclerosis where a calcium plaque has formed on the atheroma making in larger and hard. ...read more.

Middle

I doubt the relablity and generalisability of these figures, as there was no way to corroborate them. To truly judge the efficacy of statins we need a clinical trial without dietary control factors which have been shown to be as effective in reducing cholesterol 'as a low dose, first generation statinxiii'. Cardio-vascular disease is an umbrella term covering many different but interrelated symptoms and causes. Taking Statins does reduce the risk of cardiovascular disease, but by how much depends on the form that an indivuals cardiovascular event takes. It would be more helpful, instead of prescribing statins for everyone to examine their risk factors and make an indivual treatment plan to reduce there personal risk of cardiovascular disease. If a patient has extremely high blood pressure, a family history of strokes and smokes 60 a day, they will have a high risk of CVD. But that doesn't mean they have to have high cholesterol. They can still have a total cholesterol level of 160 mmol/l. This is perfectly possible and quite likely. An American study of patients who had died of CHD's lipid levels revealed that 35% of their cholesterol levels were below 200 mmol/l, with the American national average being 220 mmol/l and 250 mmol/l being considered borderline risk for cardiovascular problemsxiv. (See figure 4.) These figures suggest that 35% of people with CHD, would not have got the full benefit from statins as cholesterol problems was not their most predominate risk factor. ...read more.

Conclusion

xi Tang JL et al. Systematic review of dietary intervention trials to lower total blood cholesterol in free living subjects, British medical journals, 1998 xii Blood glucose and diabetes, HEART 2005, British medical journals xiii Clinical guidelines for prevention of CVD, British journal of cardiac nursing, 2008 xiv Framingham heart study, Lipids online http://www.lipidsonline.org/slides/slide01.cfm?q=cholesterol+distribut&dpg=1 xv Coronary heart disease: Department of Health, http://www.dh.gov.uk/en/Healthcare/Longtermconditions/Vascular/Coronaryheartdisease/DH_120 xvi Nationwide health check ups may be a waste of resources, BBC online http://news.bbc.co.uk/1/hi/health/8640182.stm xvii NJ Wald and MR Law, A strategy to reduce cardiovascular disease by more than 80%, British medical journals 2003 xviii NJ Wald and MR Law, A strategy to reduce cardiovascular disease by more than 80%, British medical journals 2003 xix Polypill 'could become a reality' BBC online, http://news.bbc.co.uk/1/hi/7971456.stm xx Clinical guidelines for prevention of CVD, British journal of cardiac nursing, 2008 xxi Clinical guidelines for prevention of CVD, British journal of cardiac nursing, 2008 xxii Clinical guidelines for prevention of CVD, British journal of cardiac nursing, 2008 xxiii Clinical guidelines for prevention of CVD, British journal of cardiac nursing, 2008 xxiv Blood Lipids and dyslipidaemia, epidemiology and clinical trial evidence, HEART 2005, British medical journals xxv Clinical guidelines for prevention of CVD, British journal of cardiac nursing, 2008 xxvi Lifestyle: smoking, diet, alcohol, physical activity, weight and body fat distribution, HEART 2005, British medical journals xxvii Clinical guidelines for prevention of CVD, British journal of cardiac nursing, 2008 xxviii Blood Lipids and dyslipiaemia, Statins and Strokes, HEART 2005, British medical journals xxix Polypill 'could become a reality' BBC online http://news.bbc.co.uk/1/hi/7971456.stm xxx Coronary heart disease: Department of Health, http://www.dh.gov.uk/en/Healthcare/Longtermconditions/Vascular/Coronaryheartdisease/DH_120 ?? ?? ?? ?? ...read more.

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