{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T13:05:09Z","timestamp":1777899909958,"version":"3.51.4"},"reference-count":32,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2016,11,26]],"date-time":"2016-11-26T00:00:00Z","timestamp":1480118400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Scott Med J"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:p>Large-scale randomised controlled trials, carried out in the context of secondary cardiovascular prevention, have shown that statins are superior to placebo: these drugs were shown to decrease cardiovascular events and total mortality. A further set of clinical trials compared high intensity to low\/standard intensity LDL cholesterol lowering in the same setting (using either statins or a statin\/ezetimibe association). In this case, a decrease in LDL cholesterol and a concomitant significant reduction in cardiovascular events were seen with intensive therapy, however with no change in total mortality. This phenomenon we may term the LDL cholesterol mortality paradox. It could be due either to the prevention (by high-intensity therapy) of episodes not severe enough to lead to the death of patients, or to high-intensity therapy leading to the death of some patients at the same time as preventing the death of others, with a null aggregate effect. Several types of adverse effects have been seen with statin therapy, such as a possible increased incidence of Diabetes mellitus and of myopathy. The decision to start high-intensity LDL cholesterol lowering (rather than low- or moderate-intensity statin treatment) should be evaluated on a case-by-case basis, taking into consideration the overall aspects of each patient, including the patient\u2019s preferences. High-intensity LDL cholesterol lowering, up to the present moment, has failed to produce a change in overall prognosis (total mortality), and should not therefore be mandatory in secondary cardiovascular prevention. It remains to be seen if a similar LDL cholesterol mortality paradox occurs with new drugs targeting plasma lipids.<\/jats:p>","DOI":"10.1177\/0036933016681913","type":"journal-article","created":{"date-parts":[[2016,11,26]],"date-time":"2016-11-26T20:20:23Z","timestamp":1480191623000},"page":"19-23","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Statins and the cholesterol mortality paradox"],"prefix":"10.1177","volume":"62","author":[{"given":"Jos\u00e9 Pedro L","family":"Nunes","sequence":"first","affiliation":[{"name":"Associate Professor, Department of Medicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal"}]}],"member":"179","published-online":{"date-parts":[[2016,11,26]]},"reference":[{"key":"bibr1-0036933016681913","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-74-1-1"},{"key":"bibr2-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1161\/01.ATV.14.7.1098"},{"key":"bibr3-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-2275(20)41379-3"},{"key":"bibr4-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199610033351401"},{"key":"bibr5-0036933016681913","first-page":"1383","volume":"344","author":"Scandinavian Simvastatin Survival Study Group","year":"1994","journal-title":"Lancet"},{"key":"bibr6-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199811053391902"},{"key":"bibr7-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.11.1307"},{"key":"bibr8-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa050461"},{"key":"bibr9-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.19.2437"},{"key":"bibr10-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60310-8"},{"key":"bibr11-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040583"},{"key":"bibr12-0036933016681913","doi-asserted-by":"crossref","first-page":"2358","DOI":"10.1016\/j.jacc.2009.10.005","volume":"54","author":"Murphy SA","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"bibr13-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1410489"},{"key":"bibr14-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61350-5"},{"key":"bibr15-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.04.070"},{"key":"bibr16-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacl.2013.01.007"},{"key":"bibr17-0036933016681913","first-page":"1475","volume":"373","author":"Nunes JPL","year":"2015","journal-title":"N Engl J Med"},{"key":"bibr18-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199512143332401"},{"key":"bibr19-0036933016681913","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0804656"},{"key":"bibr20-0036933016681913","unstructured":"Food and Drug Administration.\n                      FDA Drug Safety Communication: new restrictions, contraindications, and dose limitations for Zocor (simvastatin) to reduce the risk of muscle injury\n                      . 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