Past, present, and future clinical trials of cardiovascular risk reduction—the hyperlipidemia perspective

Abstract

In the 1990s, several randomized trials showed that long-term intervention with statin therapy reduces mortality and recurrent ischemic cardiovascular events both in individuals at increased risk of coronary heart disease (CHD) and in patients with established CHD. Since then, additional trials have illustrated the benefits of statin therapy in a variety of other high-risk patient populations. The HPS and ASCOT-LLA trials showed beneficial effects of statins in individuals with below average, average, or moderately elevated LDL cholesterol levels. The results of the ASCOT-LLA appear to conflict with those of the ALLHAT-LLT study, both of which were carried out among patients with hypertension. In the ALLHAT-LLT trial, significant cardiovascular benefits associated with statin use were not apparent. However, this appears to relate to the inadequate relative reduction in LDL and total cholesterol achieved. The cardiovascular benefits of statins also extend to the elderly and patients with diabetes. This review presents the latest data. © 2003 Elsevier B.V.