Achieving greater reductions in cardiovascular risk: lessons from statin therapy on risk measures and risk reduction

Reductions in low-density lipoprotein (LDL) cholesterol with statins have been shown to significantly reduce risk of coronary heart disease (CHD) in the primary- and secondary-prevention settings. Benefit has been observed even in high-risk patients whose baseline LDL cholesterol levels were below the drug initiation levels recommended by current treatment guidelines. Levels of non-high-density lipoprotein cholesterol or total apolipoprotein B more accurately reflect circulating levels of atherogenic particles than does LDL cholesterol concentration, and may provide a surrogate marker that correlates better to CHD event reduction after statin therapy than LDL cholesterol level. More effective lipid-lowering therapy than that currently practiced may be needed in many patients to achieve optimal CHD risk reduction.