Clinicians and patients may find recent studies relevant to decisions about lipid-lowering therapy to be perplexing. There are now, for the first time, 3 evidence-based options to modify atherosclerotic cardiovascular disease risk via lipid-lowering medications. With new information emerging, recent guidelines aging, and decisions needing to be made, this is an opportune time to review lipid-lowering therapy in the age of increasing evidence-based choice. The focus in this Viewpoint is on typical patients, not those with extreme phenotypes.
When the American College of Cardiology/American Heart Association (ACC/AHA) published the Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults1 in 2013, only the use of statins, among lipid-lowering medications, was strongly supported by evidence of improved patient outcomes. The guideline’s emphasis on statins for secondary prevention and for individuals at higher risk of disease was reinforced by a recent report that estimated the treatment of 10 000 patients for 5 years would cause 1 case of rhabdomyolysis, 5 cases of myopathy, 75 new cases of diabetes, and 7 hemorrhagic strokes while averting about 1000 events among those with preexisting disease, and 500 among those with elevated risk but without preexisting disease.2 Despite this evidence, uptake of statins remains suboptimal in the United States and elsewhere and offers an opportunity for improvement. Moreover, despite the available research, evidence is lacking about the comparative effectiveness and safety of particular statins for specific individuals.3/.../