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The correlation between cholesterol and risk reduction is unique: no J curve is seen even at extreme low levels. According to PRECISE-IVUS, the effect of intensive cholesterol lowering on plaque regression is more pronounced post-myocardial infarction syndrome than in chronic coronary disease. The importance of LDL-C lowering with ezetimibe in IMPROVE-IT (1.4 mmol/L compared to 1.8 mmol/L in the statin monotherapy arm) is expressed in several international guidelines and the indication spectrum of combination cholesterol lowering has broadened and strengthened. There is a strong evidence that myalgia during statin treatment is generally not caused by statins and it is not related to type or dose of the drug. With patience, the majority of patients can be made to become statin takers even with good quality of life; for those who cannot, ezetimibe monotherapy can be an alternative. Even though intensive cholesterol lowering is safe, avoiding statin myopathy should be emphasized. Despite the outstanding efficacy and safety of cholesterol lowering, Hungarian statin sales have decreased recently, in which driven dilettante public climate around the products may be of utmost importance. Everyone of us should counteract this according to the possibilities. Orv Hetil. 2018; 159(32): 1303-1309.

Considerable evidence suggests that "the lower the better" is a reasonable approach for reducing cardiovascular risk by lowering LDL cholesterol levels. Despite the reduction in cardiovascular events and mortality achieved by statin therapy, significant residual risk remains, especially in severe hereditary hypercholesterolemia, such as familial hypercholesterolemia. Some new strategies to achieve even lower LDL levels are now available, including the addition of cholesterol absorption inhibitor ezetimibe, and the recently available Proprotein convertase subtilisin/kexin type 9 monoclonal antibodies. In addition, new LDL drugs may be effectively administrated in those individuals who are unable to tolerate statins. The authors summarize the efficacy and clinical indications of these new agents and review the currently available guidelines. Orv. Hetil., 2016, 157(31), 1219-1223.

Ezetimibe belongs to a new class of lipid-lowering agents that selectively inhibit the intestinal absorption of cholesterol and related plant sterols. The molecular target of ezetimibe is the sterol transporter, Niemann-Pick C1-Like 1 (NPC1L1), which is responsible for the intestinal uptake of cholesterol and phytosterols. Its action is localized at the brush border of the small intestine where it inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver. Ezetimibe and statins, which are the most important part of the antihyperlipidemic therapy, have complementary mechanisms of action. It have been recently demonstrated that administration of ezetimibe with a statin not only lowers LDL cholesterol level, but is also effective in reducing the risk of heart attack and stroke.