A clear overall therapeutic benefit has been achieved by lowering LDLc with multiple statins in a subset of patients with established CHD and in primary prevention for high-risk patients. Based upon these positive benefits, statin use has increased such that recent population studies now indicate that in 2002 over 9% of the US adult population were taking some form of statin.77 However, even in controlled clinical settings, the majority of patients fail to reach their projected lipid levels and significant numbers of patients fail to achieve a therapeutic benefit as they continue to experience major coronary events while continuing statin treatment. While coronary event reductions of 25-30% are observed with statins as monotherapy, in secondary prevention trials, nearly 70% of the patients have coronary events that are not avoided. Thus, the search has continued for alternative strategies to lower LDLc or to increase the clinical effectiveness of statins using combination therapies. In those patients who have not tolerated statins, the need for safer alternative therapies is particularly acute.
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