[Hypocholesterolemic statins. Evaluation and prospects].

Statins are a family of compounds which act on cells by inhibiting hydroxymethylglutaryl (HMG) CoA reductase, an enzyme that blocks the intracellular cholesterol synthesis and stimulates the formation and action of LDL receptors. Experience of 3 years after they were introduced in France and 10 years for studies of the first compound (lovastatin) has demonstrated that these drugs are potent hypercholesterolaemia-lowering agents, fairly well tolerated but possibly with some toxicity to muscles. In severe forms of pure hypercholesterolaemia they may be prescribed either alone or combined with biliary acid chelating resins. Their use in mild forms of hypercholesterolaemia will be justified when low-dose preparations are reimbursed by the French Social Security. In mixed hyperlipidaemia, statins are more effective than fibric acid derivatives on cholesterol but weaker on triglycerides. They provide an alternative to fibric acid derivatives when these fail, but they are not indicated in hypertriglyceridaemia. Studies are being carried out to demonstrate that statins have a preventive effect on cardiovascular diseases, in either clinical regression trials or atheromatous plaque regression studies.