Treatment of hyperlipidemia with the statins: Redefining what the statins can do

Clinical evidence has established that the reduction of elevated low-density lipoprotein cholesterol levels decreases coronary heart disease events and mortality. However, despite this evidence, there is concern that low-density lipoprotein cholesterol-lowering agents are underutilized in patients who would benefit the most from treatment. Statins are the most effective agents for decreasing low-density lipoprotein cholesterol and are considered to be first-line treatment for hypercholesterolemia, after diet. Statins have also been shown to decrease triglycerides in patients with hypertriglyceridemia and to slow the progression of atherosclerosis. Statin use has been associated with significant decreases in major coronary events, stroke, and total mortality, regardless of the patient's baseline cholesterol level. Coronary benefits have been demonstrated in a wide patient group, including post-menopausal women, the elderly, hyperlipidemic diabetic patients and those with acute coronary syndromes. These outcomes reduce the use of health care resources and result in favorable cost-effectiveness ratios. As a class, statins are a well tolerated, convenient, once-daily treatment, with few adverse drug interactions. Given the weight of evidence for the clinical and economic benefits of statin therapy in both primary and secondary prevention of coronary heart disease, continued underutilization is inappropriate and unjustifiable.