During the last decade, the development of the
HMG CoA reductase inhibitors, commonly referred to as '
statins', has contributed greatly to
cholesterol lowering
therapy and cardiovascular risk reduction. These agents are well tolerated and efficacious. Data on nearly 30,000 patients from five long-term randomised, placebo-controlled trials of
statins have clearly demonstrated that a broad range of individuals can benefit from such
therapy. These include men or women, younger or older individuals, those with elevated or normal
cholesterol levels, with or without
myocardial infarction or symptomatic
coronary heart disease, with or without
hypertension or
diabetes mellitus, and those who are smokers or non-smokers. Benefits include reductions in the risks for
myocardial infarction, and coronary, cardiovascular and all-cause mortality,
stroke and the need for coronary revascularisation. Results of the recently completed Heart Protection Trial have clearly confirmed the results of the earlier trials and support the use of
statin therapy in
secondary prevention. The role of
statins in
acute coronary syndromes is being actively evaluated and appears promising. In primary prevention, the data are not as convincing and generalisations cannot be made as to whether, and in which subgroup,
drug therapy to lower
low density lipoprotein (
LDL) cholesterol should be initiated. There are important cost implications to consider and the use of
statin therapy has to be judged on an individual basis, particularly in those with high or very high
LDL cholesterol levels and/or with multiple risk factors rendering them at high short- and long-term risk of
coronary heart disease. There is evidence of a 'care gap' in translating trial data into practice, even in
secondary prevention, and this needs closing in order to improve patient outcomes.