An Update on Statin Alternatives and Adjuncts

Matthew J Sorrentino


Clin Lipidology. 2012;7(6):721-730. 

In This Article


The NCEP recommends that LDL-C is the primary target of therapy to achieve cardiovascular risk reduction in both primary and secondary prevention patients. Statins have become medications of first choice because of their efficacy in lowering LDL-C, as well as numerous outcome studies proving a cardiovascular risk reduction. As many as 10% of individuals, however, may not be able to tolerate statins. Alternative approaches need to be designed for these patients. A combination of a therapeutic lifestyle diet with careful use of supplements, such as plant stanols and sterols, as well as alternative lipid-lowering agents, can help patients achieve their LDL-C goals, and reduce cardiovascular risk.

The NCEP has emphasized a healthy lifestyle with a therapeutic lifestyle diet as the basis for cardiovascular risk reduction. In the future, greater emphasis will probably be placed on exercise and diet as a very effective way to modify cardiovascular risk as primary therapy and as adjunctive therapy to any pharmacological agents that are used. Risk reductions with a lifestyle program have the potential to mimic benefits seen with pharmacological therapy. An optimal lifestyle program can also help to avoid potential toxicity from medications. Further research to elucidate the benefits of a lifestyle program and how to easily implement these programs for our patients is needed.