Drugs that lower low-density lipoprotein cholesterol (LDL-C) concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions. They should not be used as a substitute for lifestyle changes; a combination of diet, exercise and lipid-lowering drugs is optimal for prevention of coronary disease. Lipid-regulating drugs must be taken indefinitely; when they are stopped, plasma lipoprotein levels return to pretreatment levels in 2-3 weeks.

Drugs that lower low-density lipoprotein cholesterol (LDL-C) concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions. In controlled trials in patients with coronary disease, some of these drugs have reduced mortality by 20% to 30%.

Health Canada, the Canadian equivalent of the FDA, recently issued a public advisory about postmarketing reports of myalgia, rhabdomyolysis, hepatitis, pancreatitis and thrombocytopenia associated with use of ezetimibe (Zetia in the US; Ezetrol in Canada). Ezetimibe is often added to a statin to increase LDL cholesterol lowering (Drugs for Lipids, Treat Guidel Med Lett 2005; 3:15). The advisory did not specify whether these patients were also taking a statin, but according to the Canadian manufacturer Merck Frosst/Schering (Merck/Schering-Plough in the US), some of the patients who developed rhabdomyolysis were taking ezetimibe without a statin. In the US, ezetimibe is also available in a combination with simvastatin (Vytorin - Med Lett Drugs Ther 2004; 46:73). Recently, a few patients already taking a statin developed myalgia when ezetimibe was added (R Fux et al, Ann Intern Med 2004; 140:671). The possibility that adding ezetimibe to a statin could increase the risk of rhabdomyolysis should be kept in mind.

Drugs that lower low-density lipoprotein (LDL) cholesterol concentrations can prevent formation, slow progression and cause regression of atherosclerotic lesions, and also improve vasodilatation. In controlled trials in patients with coronary disease, they have reduced mortality by 30% to 40%. Lipid-regulating drugs must be taken indefinitely; when they are stopped, plasma lipid levels return to pretreatment levels in 2-3 weeks.

New recommendations for drug treatment of hypercholesterolemia, if widely followed, will lead to a marked increase in the number of people taking lipid-regulating drugs.

The recent surge of interest in lowering serum cholesterol concentrations has led to vigorous promotion of various hypocholesterolemic drugs in the USA. Since the risk of coronary heart disease is increased in patients with high serum cholesterol concentrations, most authorities advise such patients to eat less fat and try to lose weight (The Expert Panel, Arch Intern Med, 148:36, 1988). When these measures fail, cholesterol-lowering drugs are frequently recommended.