Statin therapy: Where are we? Where do we go next?

Statin therapy reduces coronary artery disease morbidity and mortality in p rimary and secondary prevention trials including patients with elevated and average cholesterol levels. The association between reduction of total or low-density lipoprotein cholesterol and preventive benefit is well establis hed, However, additional risk factors for coronary artery disease need to b e incorporated into risk assessment to provide an accurate measure of globa l risk for use in lifestyle intervention and drug therapy guidelines. Asses sment of outcomes in the Air Force/Texas Coronary Atherosclerosis Preventio n Study primary prevention trial, which involved patients with average chol esterol levels and reduced high-density lipoprotein cholesterol (HDL-C), su ggests the importance of on-treatment values of apolipoproteins B and A-I i n predicting first major events in such a population. Other data, including trials of fibrate therapy showing reduction in coronary artery disease eve nts, support the importance of triglycerides and HDL-C in coronary artery d isease risk. Challenges for future treatment guidelines include incorporati on of emerging and novel risk factors into risk assessment, refinement of g lobal risk measurement, and simplification for application to clinical prac tice. (C) 2001 by Excerpta Medica, Inc.