Profiling risk and new therapeutic interventions: looking ahead.

The benefits of cholesterol lowering for primary and secondary prevention of coronary artery disease (CAD) have been well established. However, to accurately assess a patient's risk for CAD, clinicians must be aware of their patients' specific levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides, and not just total serum cholesterol. Clinicians must also evaluate other factors in assessing a patient's risk profile. These include smoking, weight, family history of CAD, age, hypertension, and others. Absolute risk, rather than relative risk, can then be determined. Although LDL cholesterol may be the most potent predictor of risk, triglycerides are also an important indicator of CAD risk. Currently, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors ("statins") are first-line therapy for the reduction of elevated levels of LDL cholesterol. All statins are effective in achieving some level of LDL cholesterol lowering. However, atorvastatin, which was recently introduced in the United States, has greater efficacy at maximal dosage in lowering LDL cholesterol, and also has a more beneficial effect on elevated levels of triglycerides, than other statins.