Clinical positioning of HMG-CoA reductase inhibitors in lipid management protocols

Drug treatment of dyslipidaemia has progressed dramatically over the past decade. Of the available drugs, HMG-CoA reductase inhibitors (statins) have emerged as very effective and important treatments for dyslipidaemia. These agents potently reduce low density lipoprotein (LDL) cholesterol levels (the main lipid target in management protocols and treatment guidelines) and have produced significant reductions in coronary heart disease (CHD) related morbidity and mortality, as well as overall mortality, in large intervention studies. They have also been shown to reduce progression and increase regression of coronary atherosclerosis. Statins are generally well tolerated and are thus associated with high patient compliance in comparison with the other classes of medications used for dyslipidaemia. There are minimal studies to date with these agents in patients with elevated triglycerides, either with or without accompanying elevated cholesterol levels. Preliminary results with statins in patients with hypertriglyceridaemia are promising, with reductions in triglycerides of 26 and 46%, respectively, having been reported following treatment with simvastatin and atorvastatin. Therefore, statins can be considered first-line drugs in many patients with elevated total and/or LDL-cholesterol levels according to treatment guidelines.