[Statins: intervention studies, facts and perspectives].

HMG-CoA reductase inhibitors or statins are potent hypocholesterolemic drugs. They associate a dose-dependent diminution of LDL-cholesterol (- 25 to 60%) to a raise of HDL-cholesterol (+ 5 to 12%) and a diminution of triglycerides (- 15 a 30%). Important controlled clinical trials have shown the ability of these drugs to reduce - coronary morbidity and mortality in secondary prevention (4S study with simvastatin, CARE and LIPID studies with pravastatin). - total mortality in secondary prevention (4S and LIPID studies). - coronary morbidity and mortality (AFCAPS/Tex-CAPS with lovastatin) and total mortality in primary prevention (WOSCOPS study with pravastatin). Questions still remain unanswered. To what extent do we have to lower LDL-cholesterol? What are the risks of an aggressive treatment with statins? Can we extrapolate the results of the large clinical trials to women, elderly, dyslipidemic subjects with other manifestations of atherosclerosis (i.e. cerebro-vascular, peripheral vascular diseases)? What are the benefits of an early treatment by statins in acute coronary syndromes? Can "pleiotropic" effects influence the future indications of statins? These questions will be addressed by ongoing studies which will be published within five years.