ABSTRACT

Since the previous edition of this book, lipid-lowering drug therapy, particularly with statins, has expanded beyond all belief. Expenditure on statins in many countries is now larger than for any other drug class. This has come about because in the USA, Canada, the UK and other Northern European countries,Australia and New Zealand a substantial proportion of the population exceed the cardiovascular disease (CVD) risk at which statins have been shown to be effective in clinical trials and, of course, because of the strength of that evidence. These populations have higher cholesterol levels than those of nations where atherosclerotic CVD is less common. However, within these high-risk populations statin use is no longer confined to those with the higher levels of cholesterol, because clinical trials have shown that the major indication for statin therapy is CVD risk. In addition to people previously identified as at higher than average CVD risk because of pre-existing atherosclerosis, diabetes or hypertension, many other currently apparently healthy people who are also at high risk are now being discovered as a consequence of multiple risk factor assessment, including serum cholesterol and high density lipoprotein (HDL) cholesterol. The pressure to introduce screening for CVD risk in the general population, including the determination of lipid levels, has closely paralleled the emergence of the evidence that so many of them can benefit from statin therapy. Inevitably this leads to the discovery of many people with more unusual lipid disorders, which may require additional investigation and more complex lipid-lowering treatment than statin monotherapy.