Statins: is there a need for alternative or adjunctive therapy?

摘要

In the few years since their introduction into clinical practice the 3-hydroxy-3-methyl glutaryl coenzyme A (HMGCoA) reductase inhibitors, or statins, have captured the market for cholesterol lowering drugs. They display virtually all the attributes of the ideal hypolipi-daemic agent. Total plasma cholesterol falls by 15-30% and low density lipoprotein (LDL) cholesterol by 20-40% while high density lipoprotein (HDL) cholesterol rises by 5-10% in response to regular treatment. As a bonus there is a welcome though less spectacular reduction of 10-20% in plasma triglyceride. Considerable aggregate clinical benefits accrue from these changes. The recently published results of the Scandinavian Simvastatin Survival Study (4S) indicate that simvastatin treatment of individuals with pre-existing evidence of coronary heart disease reduced their subsequent coronary mortality by 42%, their need for coronary revascularisation procedures by 37%, and, most importantly, their overall death rate by 34%.