What the statin trials have taught us.

It has taken a century since Anitschkow began feeding cholesterol to rabbits to study the role of cholesterol in atherosclerosis to be fully appreciated and for the potential of cholesterol reduction to prevent cardiovascular events to be fully realized. The body of clinical trial data testing the effects of statins on coronary heart disease is extensive and convincing. A 1% reduction in low-density lipoprotein cholesterol reduces coronary events by approximately 1%. With large doses of potent statins, low-density lipoprotein cholesterol levels and coronary events can thus be reduced by approximately 50%. The anti-inflammatory effects of large doses of atorvastatin likely contribute to the early event reduction seen early after acute coronary syndromes. Translating this information into clinical practice presents a challenge: many patients who would benefit from statins remain untreated or undertreated or discontinue treatment soon after it is initiated.