What role for [black triangle down] colesevelam in cardiovascular prevention?

As concentrations of blood total cholesterol (and LDL-cholesterol) increase, so does the risk of cardiovascular disease (CVD). Bile acid sequestrants (otherwise known as resins), were among the first lipid-altering drugs shown capable of reducing the risk of coronary heart disease in clinical trials; more recently, lowering lipid concentrations by the use of statins (HMG coA-reductase inhibitors) has been proven to reduce cardiovascular and total mortality and these drugs are now recommended as first-line therapy in both primary and secondary CVD prevention. Colesevelam ([see symbol in text] Cholestagel--Genzyme), a new bile acid sequestrant, is licensed for use in the management of primary hypercholesterolaemia, either as monotherapy when statins are not tolerated or considered inappropriate, or as an adjunct to statin therapy in patients who are not adequately controlled on a statin alone. Here, we discuss whether colesevelam has a useful role in these settings.