Recent clinical studies of the effects of lipid-modifying therapies.

Overview

Results from multiple clinical trials, primarily with the class of lipid-lowering agents known as statins, have shown that reductions in low-density lipoprotein (LDL) cholesterol are associated with reduced risk of coronary artery disease. Although LDL cholesterol is the primary target of cholesterol management strategies, increasing attention has focused on the role of inflammation, high-density lipoprotein cholesterol, and triglycerides in atherosclerosis and cardiovascular disease. We review major trials with lipid-modifying therapies published since the 2004 update of the Adult Treatment Panel (ATP) III guidelines. A pivotal trial was the Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER), which demonstrated significant reductions in cardiovascular morbidity and mortality in healthy individuals without elevated LDL cholesterol but with high levels of the inflammatory marker high-sensitivity C-reactive protein. Additional trials demonstrated the efficacy of intensive statin therapy in secondary prevention, whereas other agents, including fibrates, omega-3 fatty acids, niacin, ezetimibe, and experimental cholesteryl ester transfer protein inhibitors, have been evaluated for their ability to reduce residual cardiovascular risk.