A new reality: achieving cholesterol-lowering goals in clinical practice

Physicians often fail to achieve recommended low-density lipoprotein (LDL) cholesterol goals for their patients using lipid-lowering therapies in the primary care setting. A variety of factors may contribute to this failure, including inadequate effectiveness of lipid-lowering drugs in reducing LDL cholesterol at commonly used doses. In the Lipid Assessment Treatment Project (L-TAP), for example, the success rates for lipid-regulating therapies and treatments according to National Cholesterol Education Program (NCEP) Adult Treatment Panel II (ATP II) LDL cholesterol goals were 43% for bile acid sequestrants, 39% for niacin, 32% for gemfibrozil, 28% for psyllium fiber, 40% for statins, and 40% for combination therapy. Rosuvastatin is a new statin that has been shown to achieve significantly greater reductions in LDL cholesterol compared with pravastatin, simvastatin, and atorvastatin in primary hypercholesterolemia and enabled greater proportions of patients to achieve LDL cholesterol goals. Similarly, rosuvastatin proved superior to atorvastatin in lowering LDL cholesterol in patients with familial hypercholesterolemia, with more patients achieving LDL cholesterol goals. Data from these trials suggest that rosuvastatin is as safe and well tolerated as other statins. The availability of lipid-lowering drugs with greater LDL cholesterol-lowering effects could simplify the approach to coronary heart disease risk reduction in primary care.