[Intensive cholesterol drug lowering: how to be sure about their safety]

Cholesterol drug lowering is a paradig on how to best apply clinical evidence to clinical practice. Considering the available options, it is essential that statins have a clear safety and tolerability profile and a favourable benefit/risk relationship. Intensive cholesterol drug lowering is not associated with deleterious consequences, dependent on a greater efficacy or on serious side effects. Statins are not hepatotoxic. Enzyme fluctuation is common in dyslipidemia. The risk of increased transaminases is directly and closely related to the dosage (and type of statin used). Minor changes in baseline liver profile are not regarded as contraindications to their use (in patients with a cardiovascular justifiable risk). Iterative monitoring of the liver profile is not necessary. The etiology of miotoxicity with statins is not completely clear. The risk of myopathy or rhabdomyolysis is not related to the absolute or percent change in the LDL-C (or with the achieved LDL-C value). The adverse effects of statins may depend on the physical and chemical characteristics of the molecule and its pharmacokinetic characteristics. On a pharmacovigilance strategy the patient also has his say. The sharing of a common goal makes the patient divide responsibilities with his Health Team, encouraging safer treatments and better cardiovascular prevention. The grounds for treatment and intensive effective reduction of dyslipidemias must be made through a better adherence to quality Health Programs and through improving treatment and achieved goals.