Forecasting Cholesterol Management-End of the Statin Gold Rush?

For the last 15 years or more, lowering the low-density lipoprotein (LDL) component of total serum cholesterol has been the principal focus in cholesterol management. Ever more powerful HMG CoA reductase inhibitors (statins) captured attention in their ability to lower LDL cholesterol (LDL-C). Simvastatin was approved by the U.S. Food and Drug Administration (FDA) 15 years ago, on December 23, 1991, with evidence of LDL-C lowering of an average 41% at the 40 mg daily dose and 47% at the maximum 80 mg daily dose.1 Lovastatin, the preceding leader in the statin market, approved by the FDA 4 years earlier, on August 13, 1987, reduced LDL-C by an average 30% at the 40 mg daily dose and by 40% when taken twice daily (80 mg daily dose)2,3 (Table 1).