Statins and their role in secondary prevention of coronary heart disease

Hyperlipidaemia is a modifiable risk factor for coronary heart disease with a plethora of studies showing that the higher the concentration of cholesterol, the higher the risk of a cardiovascular event. Following an acute coronary syndrome (ACS), the patient is commenced on a lifelong drug regime, which includes atorvastatin for lipid management. However, studies looking at compliance with medication shows that adherence to cardioprotective medication, statins in particular, is poor. In 2014, the National Institute for Health and Care Excellence (NICE) revised its 2008 guidelines for the management of hyperlipidaemia. Changes include measurement of non-fasting high-density lipoprotein (HDL) at baseline and at 3 months, and looking at the percentage of reduction instead of a fixed target, to determine the efficacy of statins. Recommendation also includes commencement of a high-intensity statin, such as atorvastatin 80 mg for secondary prevention. There is a greater emphasis on the inclusion of patients in the decision-making process with regards to lipid-lowering therapies.