Beyond statins: what to expect from add-on lipid regulating therapy?

Results of recent lipid lowering trials (Table 1) where new (dalcetrapib) and established agents (niacin) were tested on a background of statin therapy have been disappointingly negative. This outcome has been the cause of much consternation for those developing new lipid regulating drugs, and prompted reflection among experts on long-cherished concepts and the practical implications of continued dependence on statin monotherapy in prevention strategies. Key current issues are summarized in the following questions: (i) Why are statins so effective and what should we do to increase their impact? (ii) What can we expect realistically from additional or add-on lipid lowering? (iii) What does the future hold?