New evidence supporting aggressive lipid lowering.

Epidemiologic and clinical studies clearly establish the relationship between low-density lipoprotein cholesterol (LDL-C) levels and coronary heart disease (CHD). As such, the National Cholesterol Education Program (NCEP) has advocated an LDL-C goal of less than 100 mg/dL in patients with established CHD and in those who are CHD risk-equivalent. Whether aggressive reductions beyond this target will provide additional decreases in CHD mortality has yet to be determined. Recent studies show that aggressive LDL-C reduction was associated with less atherosclerosis progression, lower rates of revascularization, and fewer ischemic events compared with moderate LDL-C reduction or conventional treatment. The statins are the most effective medications available for reducing LDL-C levels. Atorvastatin is the most effective of the currently available statins, but rosuvastatin, an agent in development, appears to be even more effective and allows patients with mild-to-moderate hypercholesterolemia or heterozygous familial hypercholesterolemia to achieve the recommended LDL-C targets. Statins, alone or in combination with other such medications, provide physicians with the tools to ensure that the vast majority of patients can be treated according to the current NCEP guidelines.