[Statins for cardiovascular prevention. Lowering LDL cholesterol, the primary objective]

A MAJOR CARDIOVASCULAR RISK FACTOR: LDL-cholesterol is unquestionably the principle cardiovascular risk factor, showing a continuous relationship without threshold value with the incidence of cardiovascular events. Interventional studies conducted with statins showed a significant reduction in cardiovascular risk and total mortality, which was enhanced when the absolute risk was high in the population studied. Moreover, there was a linear relationship between the decrease in cholesterol and the reduction of coronary events. FOR OPTIMAL CARDIOVASCULAR PREVENTION: Many arguments are in favor of a drastic reduction in LDL-cholesterol (< 1 g/l) for secondary prevention and in patients at high vascular risk (absolute cardiovascular risk greater than 20% over 10 years), without the possibility, today, of clearly defining the optimal target level in these patients. However, in daily practice the therapeutic aims established by national and international recommendations are rarely reached, as is shown by several epidemiological surveys. NEW THERAPEUTIC STRATEGIES: To obtain even lower levels of LDL-cholesterol, two strategies are possible, either combined with other hypolipidemic substances, such as intestinal cholesterol absorption inhibitors, or administration of more potent statins (rosuvastatin, pitavastatin). Nonetheless, the other risk factors must also be treated in order to reduce the patients' global cardiovascular risk score.