Statins: within-group comparisons, statin escape and combination therapy.

The successful use of statins in major coronary prevention trials has resulted in an explosive widening of their use. In most instances, statin therapy will result in adequate and sustained lowering of lipids. Comparing equal-weight doses, simvastatin is twice as effective as pravastatin and lovastatin in LDL-cholesterol lowering, and all three are more effective than fluvastatin according to recent comparative studies. Statin monotherapy is not always effective in severe hypercholesterolemia or in mixed (combined) hyperlipidemia with marked triglyceride elevations. All statins accepted for therapeutic use can be combined with resin or fibrate. Myopathy resulting from statin-fibrate combinations is less frequent than had been thought on the basis of early reports, and these combinations can be used in long-term therapy of mixed hyperlipidemia.