Advances in treatment of cholesterol abnormalities. The role of HMG-CoA reductase inhibitors.

The introduction of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors has provided an important new class of agents that reduce levels of total and low-density lipoprotein cholesterol more powerfully than any previously used drugs. Multiple clinical trials have shown a significant decrease in lipid values and cardiovascular events and a slowing of the progression of atherosclerosis in men and women of all ages. The Scandinavian Simvastatin Survival Study demonstrated a significant reduction in all-cause mortality as a result of reduced cardiovascular mortality. The HMG-CoA reductase inhibitors should be considered as first-line therapy for hypercholesterolemia in all patients with established atherosclerosis involving the coronary, carotid, or peripheral vessels.