Hyperlipidemia: new data and new concepts

Statins: Strategy for management of patients displaying hyperlipidemia has changed since the the first statin has been launched in France more than te n years ago. Following the first primary and secondary prevention studies c onducted with hyperlipidemic subjects, results have been extended to patien ts with cholesterol levels within normal range both in primary (AFCAPS/TexC APS) and secondary (CARE) prevention. Drug therapy has been simplified with targets tailored to the patient's risk. Open questions: Despite these important results from intervention studies w ith statins, other crucial questions remain. Among these questions the firs t one concerns the possibility that cardiovascular benefits demonstrated wi th statins are also partly due to other (pleiotropic) effects. This was fir st hypothesised when statins were proven to be efficacious after short term treatments (one year in the regression studies). The second question is wh ether we can extend the benefit observed in populations included in publish ed trials to primary prevention of stroke and to the groups less well repre sented in previous trials including women, elderly patients. The current tr ends and economic strains of every health care systems have focused on evid ence-based medicine and cost-efficacy studies. Role of triglycerides: Beyond LDL-cholesterol there is dear emergence of a role of triglyceride in cardiovascular disease as wen as new data on pathop hysiology of the so-called reverse cholesterol transport Recent trials incl uding patients with hypertriglyceridemia as well as a decline of the benefi t observed in hypertriglyceridemic patients strongly suggest that the use o f statins may have its own limitation. Importance of diet: Finally, translating results of recent trials in clinic al practice remains a challenge for treating physicians who face poor compl iance and difficulties in implementing diet in patients.