Abstract

ALCOCER DIAZ-BARREIRO, L; SOLACHE-ORTIZ, G  and  ALDRETE-VELASCO, J. The scientific legacy and the current role of atorvastatin in the management of risk of atherosclerotic cardiovascular disease. Med. interna Méx. [online]. 2018, vol.34, n.1, pp.57-71. ISSN 0186-4866.  https://doi.org/10.24245/mim.v34i1.1451.

For a long time, efforts to reduce cardiovascular risk in adults focused on the attempt to reduce plasmatic LDL cholesterol (LDLc) levels as much as possible. Until very recently, it was concluded that in clinical studies of drugs with action on circulating lipids, there was no direct evidence to determine the best LDLc target for cardiovascular risk reduction, and that adverse events, or the almost absent demonstration of impact on hard outcomes of the different pharmacological combinations recommended for the achievement of the lowest possible LDLc concentrations, were not considered. The comprehensive analysis for the update of NCEP-ATP-III (National Cholesterol Education Program, Adult Treatment Panel III), which included a large number of controlled and randomized trials, allowed in 2013 the postulation of a new treatment paradigm, which leaves the concept of specific goals of LDLc and postulates the importance of favorable lifestyle modifications and which commends the pre-ferential use of statins, fixed doses and type, because a large volume of evidence has shown that these agents attenuate the progression of coronary atherosclerosis and promote the regression of this, which significantly decrease cardiovascular morbidity and mortality in both primary and secondary prevention. In this new therapeutic paradigm, it was also possible to identify the groups of patients that can benefit from the use of statins. In more recent consensuses and guidelines, some associations support the need to achieve risk-adjusted LDLc, but keep statins as the mainstay of treatment, alone or in combination with ezetimibe or proprotein convertase subtilisin/kexin type 9 (PCKS-9) antagonists. This article reviews the clinical evidence regarding the use of atorvastatin, which allowed the development of the new cardiovascular risk management paradigm.

Keywords : Atorvastatin; Cholesterol, LDL (LDLc); Dyslipidemias; Hydroxymethylglutaryl-CoA reductase inhibitors; Hypercholesterolemia.

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