Low-density lipoprotein lowering therapy: an analysis of the options.

The hydromethylglutaryl coenzyme A (HMG CoA) reductase inhibitors, “statins,” have been remarkably effective in reducing low-density lipoprotein (LDL) cholesterol concentration, decreasing the incidence of coronary heart disease (CHD) and stroke, and extending survival (1–5). Statins inhibit the synthesis of cholesterol primarily in the liver. The hepatocyte, as its content of cholesterol decreases, responds in two ways: it decreases the production of very low-density lipoprotein (VLDL), the atherogenic precursor of LDL, and increases the production of LDL receptors that take up VLDL and LDL from plasma. These actions substantially lower the VLDL and LDL concentrations in plasma. The statin class reduces LDL cholesterol 30% to 55% from starting to maximal doses.