Statin-centric versus low-density lipoprotein-centric approach for atherosclerotic cardiovascular disease prevention: a Singapore perspective

Abstract

The link between cholesterol levels and atherosclerotic cardiovascular disease (ASCVD) is well-established.In Singapore, there is an increasing prevalence of risk factors for ASCVD. Like many Asian countries, Singapore's population is rapidly ageing and increasingly sedentary, which predisposes individuals to chronic health problems. Current international and local guidelines recommend statin therapy for the primary and secondary prevention of ASCVD. However, despite the effectiveness of statin therapy, some studies have highlighted that Asian patients with cardiovascular disease are not achieving target lipid goals. Furthermore, it is widely believed that the responses of Asians (both patients and physicians) to statin therapy are different from those of their Western counterparts. Experts convened in 2014 to determine the impact of current guidelines on clinical practice in Singapore. This review summarises the key fi ndings and recommendations of these guidelines, and presents key principles to aid clinicians to manage the cardiovascular risk of their patients more effectively.

Current management strategies to target the increasing incidence of diabetes within Pakistan

“…Angiotensin-converting enzyme (ACE) inhibitor should be prescribed early as chronic kidney disease (CKD) prevention is both cost and time effective. WHO has recommended metformin, sulfonylurea, insulin, aspirin, statin, ACE inhibitor, angiotensin receptor blocker (ARB), and thiazide as the essential medications for the management of diabetes and related NCDs 49–52…”

Nonadherence to statins: individualized intervention strategies outside the pill box

“… 55 Atorvastatin (10–80 mg) has been found to be equally efficacious and safe in Asian and Western populations. 56 , 57 Therefore, there is no regulatory warning about the dose of atorvastatin in Asians. 57 …”

Cholesterol goal achievement and lipid-lowering therapy in patients with stable or acute coronary heart disease in Singapore: results from the Dyslipidemia International Study II

“…(13) The data collected in DYSIS II supports the observation that hyperlipidaemia appears to be a significant issue in Singapore. With the increasing prevalence of other cardiovascular risk factors, including obesity and Type 2 DM, (4) rates of adverse events are likely to increase rapidly if more effective management is not implemented.…”

“…(2,3) With rising levels of obesity and Type 2 diabetes mellitus (DM), the situation is set to get worse over the coming years. (4) Effective management of the risk factors associated with CHD is therefore essential for reducing the burden of cardiovascular disease in Singapore.…”