Should we lower cholesterol as much as possible?

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Abstract
Are higher statin doses safe? To achieve this new goal, people at high risk would have to take higher statin doses than currently suggested. This would increase the risk of adverse side effects. In the treating to new targets (TNT) trial, the only study comparing a low and high dose of the same statin, not even 80 mg atorvastatin was able to lower mean low density lipoprotein cholesterol below 1.81 mmol/l.3 Clinical experience has taught us that a dose increase of that size of any drug will inevitably increase both the number and the seriousness of side effects. This apparently did not concern the authors, who concluded, “Intensive lipid lowering therapy with 80 mg of atorvastatin per day in patients with stable CHD [coronary heart disease] provides significant clinical benefit.” However, overall mortality was not reduced because the smaller number of cardiovascular deaths in the 80 mg atorvastatin group was offset by increased deaths from other causes leaving a benefit of 250 (5%) fewer non-fatal cardiovascular events. Because many non-fatal events resolve with little residual damage or discomfort, meticulous recording of all possible adverse side effects is mandatory. However, the authors have not provided adequate information on adverse events.4 5