Who should receive high-dose statin therapy?
Dr. Kussmaul: Cholesterol measurement and treatment guidelines have been evolving over time. At one point clinicians only looked at their patients’ total cholesterol, but now we know that there is “good” (HDL) and “bad” (LDL) cholesterol. The recent controversy has been about how low we should go with LDL targets. Should our goal be 130, 100, or 70 mg/Ll? Also, there’s controversy about whether or not LDL targets matter that much, or if higher doses of statins, regardless of blood levels of LDL, are simply better for patients. Dr. Val: And what about the high-sensitivity CRP test? Should that be used as a screening tool? Dr. Kussmaul: My highly educated patients ask me to check their CRP levels more often than I think is necessary. Enthusiasm about CRP was ignited by JUPITER, where they found that people with low LDL levels but high CRPs benefited from starting statins as a primary prevention strategy. Dr. Val: After JUPITER was released, I remember the media reporting that we may as w
