Implications of the obesity epidemic for statin therapy: shifting cholesterol metabolism to a high synthesis and low dietary absorption state.

Obesity and the metabolic syndrome are becoming one of the biggest health challenges of the 21(st) century. Cholesterol metabolism is significantly altered in both obesity and metabolic syndrome in that cholesterol synthesis is increased and absorption reduced and this has important implications for the treatment of lipid disorders in both obesity and the metabolic syndrome. In the present review we discuss these changes in detail especially in the context of a more standardized approach for cholesterol reduction like the TARGET LDL trial. Customized care is topical in lipidology as we strive to achieve LDL cholesterol and non-HDL cholesterol targets in every patient.