ABSTRACT
The statins are undoubtedly a great advance in the management of severe hypercholesterolaemia. Most patients respond well to them. A small number who genuinely take their medication are truly resistant to their cholesterol-lowering effect.81 The reasons for this are unclear, but the phenomenon could be explained if these patients already have low rates of cholesterol biosynthesis, perhaps because they are hyperabsorbers of intestinal cholesterol, for example as associated with the apo E4 genotype.
