Cholesterol and its biological significance. Atherosclerosis. Statin therapy (part 2)

Over the past decades, lipid-lowering therapy, which is essentially limited today to the prescription of statins, has become extremely popular in cardiology for the primary and secondary prevention of cardiovascular diseases of atherosclerotic nature. Prescription of statins to cardiac patients is a mandatory element of comprehensive treatment. However, one must admit that treatment with statins is characterized by many unresolved problems: the feasibility of primary prevention with statins has not been proven in particular in young people; no data regarding the true frequency of side effects were obtained especially for the long-term follow-up; the principles of control during treatment were not identified; the target levels of low-density lipoprotein cholesterol (LDL-C) that physician should strive to achieve are also questionable; and most importantly, the question of the true effectiveness of lipid-lowering therapy itself remains open since there are no clear signs of causal associations between serum cholesterol levels and cardiovascular events. The purpose of the review is to draw attention of researchers to this issue and to show that the mechanisms of atherogenesis are more complex, and that only cholesterol-lowering therapy with statins does not completely solve the problem.