Relationship between cholesterol synthesis and intestinal absorption is associated with cardiovascular risk

Hypercholesterolemia is a major risk factor for cardiovascular disease. The HMG-CoA-reductase inhibitors, statins, reduce plasma cholesterol and, as a consequence, decrease cardiovascular morbidity and mortality. Data from a subgroup analysis of the 4-S Study, however, indicate that patients with high cholesterol absorption may not benefit from statin treatment. Furthermore, there is accumulating evidence that lower hepatic synthesis and higher intestinal absorption markers are associated with increased cardiovascular risk. Therefore, prospective clinical trials are needed to evaluate whether subjects with altered cholesterol homeostasis may benefit from treatment strategies that reduce cholesterol absorption in addition to statin treatment.