Cardiovascular disease and coronary artery disease are still the leading cause of morbidity and mortality in industrialized countries, including Italy. One of the main risk factors for the development and progression of atherosclerosis is dyslipidemia, due to congenital metabolic disorders or secondary to specific diseases such as diabetes. Hypercholesterolaemia (i.e. high blood cholesterol levels) and cardiovascular disease are two of the most significant and economically burdensome chronic conditions from a social and health perspective in Italy, imposing significant health costs, with an enormous impact on the quality of life of patients.
Hypercholesterolaemia is conventionally defined as a serum total cholesterol level steadily above 200 mg/dL. However, it should be noted that, for prognostic and therapeutic purposes, a correct interpretation of serum cholesterol concentrations should take into account other possibly associated coronary risk factors (hypertension, cigarette smoking, diabetes, etc.), since the presence of two or more of these risk factors increases the overall risk considerably. Fasting triglyceride values >150 mg/dl expose patients to an increased risk of coronary heart disease (CAD), especially if associated with low HDL-cholesterol levels. High density lipoprotein (HDL)-bound cholesterol (HDL-C) is protective against atherogenesis (the so-called “good” cholesterol), while the role of low-density lipoprotein (LDL) bound cholesterol (LDL-C) is well-established in the development of atherosclerosis (the so-called “bad” cholesterol). Several studies have shown that LDLs are the most atherogenic lipoproteins. Accordingly, the reference indicator for initiation and monitoring of lipid-lowering treatments is LDL cholesterol, which is responsible for the formation of atherosclerotic plaques that reduce blood flow within the vessels.
The higher the level of risk, the lower the LDL cholesterol target levels should be, in order to protect the patient from the potential manifestations of cardiovascular disease. Therefore, identifying pharmacological interventions able to control LDL cholesterol levels and to reduce the incidence of major cardiovascular events is certainly among the priority objectives for the primary and secondary prevention of atherosclerotic disease.In this regard, the efficacy of statins in lowering LDL cholesterol and in reducing the risk of atherosclerotic cardiovascular disease is well documented by scientific evidence and is widely recognised by international guidelines.