Statin Trials and Goals of Cholesterol-Lowering Therapy

Hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) are a breakthrough in the treatment of high serum cholesterol. Several recent clinical trials 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 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. 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 ,130 mg/dL. For patients with CHD or other atherosclerotic diseases, the goal of NCEP is an LDL cholesterol of #100 mg/dL. These therapeutic goals derive from judgments based on epidemiological data and clinical trial results available at the time of reporting.