Evidence mandating earlier and more aggressive treatment of hypercholesterolemia

With the advent of the statins, enormous progress has been made in the management of hypercholesterolemia. However, some authorities point out, quite correctly, that statin treatment reduces event rates by "only" ≈30% and suggest that preventing the other 70% will require more than just control of hypercholesterolemia (eg, adjunctive use of antiinflammatory or immunologic interventions). This may discourage clinicians from pressing on to do the best that can be done with the interventional tools already at hand. This review has summarized the evidence, drawn from a variety of sources, that the results of the 5-year statin trials seriously underestimate the ultimate potential of cholesterol-lowering therapy. We suggest that this evidence mandates continuing and more aggressive use of lipid-lowering regimens and, even more important, intervention at an earlier stage in the development of the atherosclerotic lesion © 2008 American Heart Association. Tnc.