Statins: intervention studies facts and perspectives

HMG-CoA reductase inhibitors or statins are potent hypocholesterolemic drug s. They associate a dose-dependent diminution of LDL-cholesterol (-25 to 60 %) to a raise of HDL-cholesterol (+5 to 12 %) and a diminution of triglyce rides (-15 a 30 %). Important controlled clinical trials have shown the abi lity of these drugs to reduce - coronary morbidity and mortality in seconda ry prevention (4S study with simvastatin, CARE and LIPID studies with prava statin). - total mortality in secondary prevention (4S and LIPID studies). - coronary morbidity and mortality (AFCAPS/Tex-CAPS with lovastatin) and to tal mortality in primary prevention (WOSCOPS study with pravastatin). Questions still remain unanswered. To what extent do we have to lower LDL-c holesterol ? What are the risks of an aggressive treatment with statins ? C an we extrapolate the results of the large clinical trials to women, elderl y, dyslipidemic subjects with other manifestations of atherosclerosis (i.e. cerebro-vascular, peripheral vascular diseases) ? What are the benefits of an early treatment by statins in acute coronary syndroms ? Can << pleiotro pic >> effects influence the future indications of statins ? These question s will be addressed by ongoing studies which will be published within five years.