Cardiovascular diseases in the western industrialized nations and the associated cost for the state and society (Part 2)

High serum cholesterol levels are understood as one of the main risk factors of coronary heart diseases, stroke and other atherosclerosis-related diseases like peripheral arterial occlusive disease (PAOD). Since 1987, when Lovastatin as the first statin became available for pre-scription after three decades of research statins started to a triumphal march becoming the world's best selling branded drugs until 2012, when the first generic statins could be sold due to the expiration of patents. Lipitor, an atorvastatin, was the best-selling branded drug in the history of pharmaceuticals. At present, most statins are available for prescription also as ge-neric drugs making them much more affordable also for a widespread use in low risk popula-tions. At a first step, in the present article the basics of the pharmacological properties and effects of statins are discussed showing that statins differ among each other for instance trough their bioavailability and elimination time both factors influencing their biological ef-fects and, furthermore, the potential side effects of this class of drugs. In a second step, the different statin-related strategies are described. While there is not too much doubting about the benefits of statins for secondary prevention their use for primary prevention is highly con-troversial. New American guidelines suggest that almost everyone is eligible for a statin ther-apy irrespective of whether he is suffering from any atherosclerosis-related disease whilst the risk assessement of European Guidelines leads to a considerable lower number of potential patients. The effects of different approaches of risk assessment related to the use of statins are shown in the final section of this article.