Cholesterol management and the reduction of cardiovascular risk

The increasing number of outcomes-based clinical trials addressing cardiovascular risk factor reduction using statin therapy has resulted in a substantial revision of the management of patients at risk for cardiovascular events. The clinical trials involve both primary and secondary preventive care. This review outlines the trials addressing primary and secondary prevention, detailing the more recently published studies, their place in risk-factor management, and their relationship to the National Cholesterol Education Program guidelines. Available data in elderly patients are reviewed, as are the adverse effects of the different statins and the statin drugs undergoing preliminary trials but not yet approved for general clinical use. The underuse of statin therapy is also addressed. Conclusions are drawn regarding the appropriate use of statin therapy in the contemporary primary and secondary preventive management of patients to reduce cardiovascular mortality and morbidity.