Intensive reduction of low-density lipoprotein-cholesterol: implications of recent trials

Strong evidence supports the use of HMG-CoA reductase inhibitors (statins) for preventing ischemic events in a variety of clinical settings. Benefits have been documented in primary and secondary prevention, across a range of baseline cholesterol levels, in the young and old, and in patients with varying manifestations of cardiovascular disease. Epidemiologic evidence suggests that risk is associated with serum cholesterol in a continuous, graded fashion with no clear threshold below which further reductions in risk do not occur. In aggregate, the placebo-controlled statin trials strongly suggest that the magnitude of risk reduction is related to the degree of cholesterol lowering achieved. However, until recently, it was unknown whether intensified cholesterol lowering with higher doses of newer, more potent statins could bring further gains over a policy of moderate or conventional lipid lowering. This article summarizes the results of randomized trials comparing these two strategies in patients with a history of coronary artery disease.