Statin Trials and Goals of Cholesterol-Lowering Therapy

ydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are a breakthrough in the treatment of high serum cholesterol.Several recent clinical trials 1-3 demonstrate that statins can substantially reduce both morbidity and mortality from CHD.They are becoming a mainstay in management of patients with established CHD (secondary prevention), and they hold promise for high-risk patients without evident CHD (primary prevention).The introduction of statins occurred about the same time as the initiation of the NCEP; this program is a national effort to increase public and professional awareness of the dangers of high serum cholesterol and to emphasize the benefits of reducing serum cholesterol concentrations.Besides the NCEP's public health effort 4 to lower serum cholesterol levels in the general public through modification of life habits, the NCEP has established guidelines for cholesterol management in both secondary prevention and high-risk primary prevention.5,6 These guidelines identify LDL cholesterol as the primary target of therapy, and they specify goals for LDL cholesterol-lowering therapy.For example, the NCEP recommended that high-risk patients who have elevated LDL cholesterol levels but not clinical CHD or other atherosclerotic disease should have their LDL cholesterol concentration reduced to Ͻ130 mg/dL.5,6 For patients with CHD or other atherosclerotic diseases, the goal of NCEP is an LDL cholesterol of Յ100 mg/dL.5,6 These therapeutic goals derive from judgments based on epidemiological data and clinical trial results available at the time of reporting.