The statin era: in search of the ideal lipid regulating agent

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Abstract
Over the past decade, the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, have established themselves as among the most successful of all classes of cardiovascular drugs. Significant reductions in recurrent myocardial infarction, stroke, and death have been demonstrated in a series of landmark trials of statins in individuals with coronary heart disease (CHD) and high or normal blood cholesterol concentrations.1-3 Primary prevention with statins has also been shown in large populations of asymptomatic individuals at increased risk for coronary disease4 5(fig 1). Aggressive statin treatment has been found to prevent or defer subsequent events in patients after coronary bypass graft surgery6 and to be as effective as angioplasty in delaying events in patients with stable angina.7 New studies are under way to explore the use of statins to prevent first or recurrent stroke, peripheral vascular disease, diabetic complications, and other conditions. Figure 1 Landmark clinical event trials: relevance to clinical practice. A series of landmark clinical event trials have demonstrated the benefits of statins for primary and secondary prevention. These benefits have been seen in patients with coronary heart disease and high or normal blood cholesterol concentrations, as well as in asymptomatic patients at increased risk for coronary heart disease. 4S, Scandinavian simvastatin survival study; LIPID, long-term intervention with pravastatin in ischemic disease; CARE, cholesterol and recurrent events trial; WOSCOPS, West of Scotland coronary prevention study; AFCAPS/TexCAPS, Air Force/Texas coronary atherosclerosis prevention study. With their extensive clinical trial track record, statins are by far the most prescribed class of lipid regulating drugs, with worldwide sales that approach US$10 billion annually. Although various types of new lipid regulating agents are in development, none appears likely to supplant the statin hegemony in the near future. Nevertheless, even in the midst of the “statin era” in the management of …

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