Introduction

Abstract

Based on evidence from the basic sciences, epidemiologic studies, and clinical trials, hypercholesterolemia is well established as a major risk factor for atherosclerotic cardiovascular disease. An exciting development over the past 2 decades has been the identification and evaluation of increasingly effective pharmaceutical interventions to beneficially modify the lipoprotein profile. A rich database from randomized trials using anatomic and clinical end points has resulted in the organization of the National Cholesterol Education Program (NCEP) and the issuance of 3 reports from its Adult Treatment Panels (ATPs) in 1989, 1993, and 2001. 1 Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. Bethesda, MD: US Dept of Health and Human Services, Public Health Service, National Institutes of Health, 1989. NIH Publication No. 89-2925 Google Scholar , 2 Summary of the second report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). JAMA 1993;269:3015–3023 Google Scholar , 3 National Institutes of Health. Third Report of the National Cholesterol Education Program Expert Panel on Retention, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Executive Summary. Washington, DC: Government Printing Office, 2001. NIH Publication No. 01-3670 Google Scholar These guidelines emphasize the effectiveness of reduction in low-density lipoprotein (LDL) cholesterol through therapeutic lifestyle changes (diet, exercise, weight control) and, in persons with moderate or high risk of coronary artery disease (CAD), pharmacologic interventions to prevent either initial or recurrent myocardial infarction (MI), cardiac death, and a host of other clinical end points. 3 National Institutes of Health. Third Report of the National Cholesterol Education Program Expert Panel on Retention, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Executive Summary. Washington, DC: Government Printing Office, 2001. NIH Publication No. 01-3670 Google Scholar The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, or statins, have rightfully emerged as the most commonly prescribed first-line drug therapy based on their LDL-lowering potency and their efficacy and safety as shown in numerous clinical trials. Thomas A. Pearson, MD, PhD, MPH