[Benefits of intensive reduction of low density lipoprotein cholesterol].

The role of elevated cholesterol in the initiation and progression of atherosclerosis is universally recognized. In the last 14 years, the inhibitors of the 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG CoA) reductase (statins) have become one of the most widely used therapeutic agents to lower cholesterol levels. Individual large clinical trials, as well as a meta-analysis of five of these studies, have clearly demonstrated the effect of statin-induced low-density lipoprotein cholesterol (LDL-C) lowering in significantly reducing the risk of coronary events in patients with a history of coronary artery disease (CAD). However, there are a few remaining questions, and the most important uncertainty is to what extent should cholesterol be reduced? The results of three large ongoing trials, specifically designed to answer this question, will be available in about two years. In the meantime, this paper presents a short review of the data derived from epidemiological studies and large intervention trials, suggesting that, in patients at high risk, the lower the LDL-C induced by treatment, the better the chance of reducing the incidence of cardiovascular events.