What do the statin trials tell us?

The results of five large-scale, randomized, placebo-controlled trials, inv olving nearly 31,000 subjects, attest to the benefits of statins in the pre vention of coronary events. Several key observations can be made on the bas is of the evidence from these investigations. Of primary importance is the fact that statins reduce coronary event rates in patients with or without c oronary heart disease. The percentage reduction in risk increases with each successive year of statin therapy. Moreover, the risk reduction is proport ional to the reduction in low-density lipoprotein cholesterol. Subgroup ana lyses have demonstrated that the efficacy of statins extends to specific su bgroups of patients, including women, people with diabetes, and older indiv iduals. These agents also reduce the risk of stroke and transient ischemic attacks in patients with coronary disease. Both the randomized trials and w idespread clinical experience have confirmed that statins are safe and do n ot increase the risk of cancer or mortality. Several markers of atheroscler otic risk are ameliorated by statins. although the clinical significance of this observation remains under investigation. The broad range of the thera peutic effects of statins yields safe, effective management of hypercholest erolemia in current practice while also providing a foundation for addition al therapeutic refinements in the future.