Guidelines of lipid therapy translation into clinical practice

: Alterations in lipid metabolism play a major role in the pathogenesis of atherosclerosis and are an important risk factor for cardiovascular events. Lowering of LDL cholesterol by statins reduces morbidity and mortality in patients with coronary artery disease (CAD), both in primary and secondary prevention. The results of large controlled trials that included more than 50,000 patients are the basis for target values promoted by current guidelines. According to the NCEP-ATP III guidelines LDL cholesterol should be lowered to less than 100 mg/dl in high risk patients (CAD or CAD equivalent) and in very high risk patients optional to less than 70 mg/dl. Up to now even in high risk patients the recommended goals are not sufficiently achieved: Up to 80% of high risk patients do not receive a statin and only a minority of those being treated with a statin have a LDL cholesterol below 100 mg/dl. Furthermore, after a major event (e.g. myocardial infarction) the quality of lipid reduction decreases over time. Further efforts are required to improve this situation as a guide-line oriented approach may help to prevent up to 100,000 myocardial infarctions and deaths alone in high risk patients in Germany.