Lipid lowering: statins and the future

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Abstract
Cardiovascular disease (CVD) is the leading cause of death in developed and many developing countries. Between 1970 and 1992 there has been a slow decline in some areas, notably North America, Western Europe, Australia, and New Zealand.1 However, CVD mortality has recently increased in Eastern and Central Europe. A whole spectrum of therapeutic tools is available to manage CVD including thrombolytics, antiplatelet drugs, β blockers, angiotensin converting enzyme (ACE) inhibitors, and statins. By using these drugs singly or in combination, CVD risk can be reduced by as much as 50%. 1987 was a pivotal year for statins. It was the first year that statin treatment became widely available and the first statin, lovastatin, was marketed in the USA. At the same time the first treatment guidelines were released providing recommendations based on the emerging evidence.2 3 Moreover, there was the first official recognition of the relation between raised cholesterol concentrations and coronary heart disease risk. At that time there were sceptics who did not believe that lowering cholesterol would have mortality benefits, and some even suggested that lipid lowering drugs could have fatal side effects. Major clinical trials …

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