Pharmacological management of hyperlipidaemia

Coronary heart disease (CHD) is a major cause of morbidity and mortality. Recent evidence supports the benefits of intensive low density lipoprotein-cholesterol (LDL-c) reduc-of intensive low density lipoprotein-cholesterol (LDL-c) reduction on CHD risk with various ongoing end point trials addressing the issue of optimal cholesterol reduction. Statins reduce LDL-c, and have been shown to reduce CHD event rates in both primary and secondary prevention trials. The magnitude of this effect is not fully accounted for by LDL-c reduction alone and may relate to effects on other lipid parameters. Fibrates represent the best treatment for raising high density lipoprotein-cholesterol (HDL-c) and a variety of agents, which specifically target HDL-c, are under development. New therapies being developed to meet the challenge of intensive cholesterol lowering include rosuvastatin, a potent statin, producing reductions in LDL-c of up to 69% and ezetimibe, a selective cholesterol absorption inhibitor, producing reductions in LDL-c of up to 25%. This review summarises the evidence regarding dyslipidaemia and vascular risk and how advances in lipid-lowering therapy may be important in future management of hyperlipidaemia.