[Statins with a perspective of lifelong therapy]

Abstract

LDL cholesterol is the primary target of treatment for lowering the risk of cardiovascular events in both primary and secondary prevention. The usual drug to achieve this goal is HMG-CoA reductase inhibitors (statins), which constitute the most potent and effective class to reduce LDL cholesterol. Statins have been shown to be associated with good patient compliance, lower adverse events, and few drug interactions. Clinical trials have demonstrated that statin therapy reduces all clinical manifestations of atherosclerotic disease. These trials have also shown that the amount of risk reduction achieved is closely related to the degree of adherence to treatment. Despite evidence for the benefits of LDL-lowering with statins, initiation of treatment, achievement of the goals, and long-term adherence to therapy remain far from optimal. However, in order to achieve maximum benefit from statin therapy as seen in clinical trials, it is important that patients receive optimal-dose therapy for the rest of their lives. This review is concerned with a combination of patient-, physician-, and health delivery system-focused interventions, as outlined by the ATP III guidelines to improve adherence in clinical practice.