[Current therapy of hypercholesterolemia. How much statin does your patient need?]

Today, statins play an important role in the treatment of hypercholesterolemia. They have two effects on the metabolism of cholesterol: firstly, they reduce the synthesis of cholesterol and secondly they stimulate the expression of LDL receptors. LDL is reduced via both of the mechanisms. Various studies (the 4S, LIPID and CARE studies) have demonstrated the efficacy of statins in secondary prevention, that is, in patients with hypercholesterolemia and CAD. In the CARE study, for example, the statins reduced the incidence of fatal and non-fatal myocardial infarctions by 24%. A number of studies show that although primary prevention is effective, long-term tolerability is still a matter of controversy. A relatively frequent, dose-dependent side effect is myopathy, which has a reported incidence of 0.1-0.5%. In combination with fibrates, the incidence increases, and cases of rhabdomyolysis, some fatal, have been described. To minimize the side effects of statin treatment, therefore, target levels--which must be derived on the basis of the results of large studies--must be established for the individual patient.