Importance of statins in the treatment of dyslipidemia

Progression of atherosclerosis is related to the complex interplay between dyslipidemia, inflammation, and thrombosis. Numerous large, randomized, controlled trials have documented that cholesterol lowering therapy with 3-hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) reduce the risk for cardiovascular events in individuals with or without a history of coronary artery disease. Statins are the first-line therapy for the treatment of dyslipidemia because of their particular efficacy in decreasing low-density lipoprotein (LDL) cholesterol, as well as increasing high-density lipoprotein (HDL) cholesterol, and lowering triglyceride levels. Statins have been shown to decrease coronary morbidity and mortality in many large primary and secondary prevention trials. Although these effects are primarily attributed to their lipid lowering efficacy, subgroup analyses of these trials indicate that they also have cardioprotective effects. These pleiotropic effects of statins include improvements in endothelial function, augmentation of nitric oxide bioavailability, antioxidant effects, stabilization of atherosclerotic plaques, and decreasing vascular inflammation. In general, statins are safe and well-tolerated. Standard doses of statins rarely cause myopathy and rhabdomyolysis in muscle tissue, or elevation of liver transaminases. Data from many large, ongoing trials indicate that statin therapy will continue to be the most effective alternative in the treatment of dyslipidemia and in cardiovascular risk reduction.