title: [Therapeutic and pleiotropic effects of statins in primary and secondary prevention of atherosclerosis].
abstract: Strategy for management of patients displaying hyperlipidemia has changed since the first statin has been launched in France more than ten years ago. Following the first primary and secondary prevention studies conducted with hyperlipidemic subjects, results have been extended to patients with cholesterol levels within normal range both in primary (AFCAPS/TexCAPS) and secondary (CARE) prevention. Drug therapy has been simplified with targets tailored to the patient's risk. Despite these important results from intervention studies with statins, other crucial questions remain. Among these questions the first one concerns the possibility that cardiovascular benefits demonstrated with statins are also partly due to other (pleiotropic) effects. This was first hypothesised when statins were proven to be efficacious after short term treatments (one year in the regression studies). The second question is whether we can extend the benefit observed in populations included in published trials to primary prevention of stroke and to the groups less well represented in previous trials including women, elderly patients. The current trends and economic strains of every health care systems have focused on evidence-based medicine and cost-efficacy studies. Beyond LDL-cholesterol there is clear emergence of a role of triglyceride in cardiovascular disease as well as new data on pathophysiology of the so-called reverse cholesterol transport. Recent trials including patients with hypertriglyceridemia as well as a decline of the benefit observed in hypertriglyceridemic patients strongly suggest that the use of statins may have its own limitation. Finally, translating results of recent trials in clinical practice remains a challenge for treating physicians who face poor compliance and difficulties in implementing diet in patients.
authors.affiliation: Service d'Endocrinologie-métabolisme, Unité de prévention des maladies cardiovasculaires, Hôpital Pitié-Salpêtrière, 47, 83 bld de l'hôpital-75651 Paris. eric.bruckert@psl.ap-hop-paris.fr
authors.forename: E
authors.initials: E
authors.lastname: Bruckert
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001161:Arteriosclerosis / Q000517:prevention & control*; D003327:Coronary Disease / Q000517:prevention & control; D004359:Drug Therapy, Combination; D006801:Humans; D008148:Lovastatin / Q000627:therapeutic use*; D012106:Research
chemical_list: D000924:Anticholesteremic Agents; D008148:Lovastatin