Statins for cardiovascular prevention: is there still a place for cholesterol measurement?

peer reviewedStatins, the most popular lipid-lowering agents, have proven their efficacy in preventing cardiovascular events in subjects with lower and lower initial plasma cholesterol levels. Besides, the protective effect does not seem to be directly related neither to the degree of the cholesterol reduction nor to the final level of plasma cholesterol level reached under treatment. Such observations suggest that statins may exert vascular protective effects, at least in part, independently of their specific cholesterol-lowering effect (so-called pleiotropic effects). The present paper will discuss the arguments pro and contra the dosage of cholesterolaemia before initiating a therapy with statin and during treatment follow up, both in subjects with previous cardiovascular events (secondary prevention) and in subjects with a high cardiovascular absolute risk but without previous clinical expression of atherosclerosis (primary prevention)