Cardiovascular disease (CVD) is the greatest epidemic of mankind. It is the single most important cause of death for both men and women, despite the fact that with the use of modern medicine it can often be prevented or at least postponed. (1) Overall, CVD is estimated to cost the EU economy almost 196 billion euros a year. These costs are the sum of health care costs, costs due to productivity losses, and costs due to the informal care of people with CVD. (2) CVD prevention is therefore remaining a major challenge for the general population. Fortunately, over the past years we have been witnessing a reduction of CVD mortality in many European countries, which is mainly the result of increasing preventive strategies. It is estimated that 50% of the reductions seen in coronary heart disease (CHD) mortality are related to changes in risk factors, and 40% to improved treatments. Prevention is typically categorised as primary or secondary prevention, although in CVD the distinction between the two is arbitrary in view of the underlying, gradually developing atherosclerotic process. CVD risk is most frequently the result of multiple interacting risk factors. Serious cardiovascular (CV) events often occur in persons with no prior manifestation of the disease. Therefore, it is important to act preventively before disease has progressed up to a point where clinical symptoms cause damage to the CV system or even death. (1)

A risk estimation system, such as SCORE, can assist in making decisions which asymptomatic adults without evidence of CVD require medical intervention. It estimates the 10-year risk for a first fatal atherosclerotic event, whether heart attack, stroke, aneurysm of the aorta, or other. In general, individuals at a risk of CVD death of ≥5% are classified into the high CV risk category and they qualify for the consideration of introducing statin therapy, when lifestyle changes do not suffice. Certain individuals who are at high or very high CVD risk (patients with established CVD, diabetes, moderate to severe renal disease and very high levels of individual risk factors) do not need risk scoring and require immediate intervention for all risk factors. (1)

A high cholesterol level is one of the major modifiable risk factors for developing CVD. Consequently, recently published European CVD prevention guidelines recommend that the reduction of LDL cholesterol must be of prime concern in the prevention of CVD. This is where statins — as a first-line treatment for the reduction of LDL cholesterol levels — play a critical role. Of course, the cornerstones of the treatment of patients with elevated cholesterol levels have to be appropriate diet and other non-pharmacological measures (exercise, reduction of weight). However, these interventions can be inadequate, especially in patients with high cholesterol le vels or in patients at higher risk. (1) With modern, potent statins, such as rosuvastatin, we can reduce LDL cholesterol levels by up to 55%, and so, by eliminating one of the main risk factors for developing CVD, we can reduce the individuals total CV risk. (1, 3) It has been established that an LDL cholesterol reduction of 1% reduces the risk for CHD by 1% (Table 1). (4)

A number of large-scale clinical trials have demonstrated that statins substantially reduce CV morbidity and mortality in patients in primary and secondary prevention. (5-7) On the basis of a large clinical study with rosuvastatin, which was aimed to justify the use of statin therapy in primary prevention, an addition of a new indication to statin labels was approved by European health authorities: prevention of major CV events in patients who are estimated to have a high risk for a first CV event, as an adjunct to correction of other risk factors. A post hoc analysis of this clinical study which included only patients considered at high risk, as defined either by a Framingham risk score of 20% or a European systematic coronary risk evaluation (SCORE) score of ≥5% was made. When compared with the entire study cohort, the higher-risk patients were older, more often male and more likely to smoke, had hypertension and low levels of HDL cholesterol. The results of the sub-analysis showed that patients with a 10-year Framingham risk score of >20% or an estimated SCORE risk of >5% had statistically significant reductions, 50% and 43%, respectively, in the risk of myocardial infarction, stroke, or cardiovascular death when treated with rosuvastatin compared with patients treated with placebo. (8)

In recent years, several studies have proved that rosuvastatin not only slows progression but may even promote regression of atherosclerosis, especially when used in high doses. (9, 10) Rosuvastatin may also prevent the development and progression of atherosclerosis in diabetic patients, who normally have a two to threefold higher risk of CV events — not only by reducing the serum cholesterol level but also by improving cholesterol efflux from foam cells of the arterial wall via blocking the harmful effects of advanced glycation end products on macrophages. (11, 12)

Hypercholesterolemia frequently co-exists with hypertension, a major risk factor for strokes and heart attacks as well as heart failure, renal impairment, peripheral vascular disease and blindness. (11) Adding lipid lowering therapy can be beneficial to hypertensive patients. It has been established that a 10% reduction in blood cholesterol and blood pressure could reduce major CVD events by 45%. (13) Moreover, rosuvastatin therapy added to conventional anti-hypertensive treatment, improved the left ventricular diastolic function and produced favourable effects on arteriosclerotic plaques in these patients. (14)

Atherosclerosis is a progressive disease, therefore prevention of CVD and control over the main risk factors for its development should be a lifelong approach. (1) Long-term compliance with statin therapy is critical for its efficacy in patients at high risk where pharmacologic therapy is indicated in addition to lifestyle interventions. (8) The CV risk reduction increases with every additional year of statin treatment. (15) Furthermore, a recently published trial using intravascular ultrasound examination has shown that a 4-year vs 8-month statin treatment by more than 4-times decreases the external elastic membrane volume (-1.1% at 8 months and -5.9% at 4 years). (16)

Krka has a long-standing experience in the area of treating CVD and has been engaged in the management of hypercholesterolemia since 1996, when its first statin, lovastatin, was approved. (17) Since then, Krka has been continually extending its hypolipemic portfolio, which is today one of the widest on the market. Krka’s rosuvastatin, Roswera®, is a most current addition to this portfolio, and by being soon available in additional doses of 15 mg and 30 mg it will offer the fullest range of rosuvastatin-based treatment options on the market. (18) Rosuvastatin, the most potent statin for reducing LDL cholesterol levels, is the statin for which the benefits in primary preventive strategy were first proven. (3, 7) Due to the high-quality of vertically integrated products and production complying with the strictest European and international production and pharmaceutical standards, Krka’s statins are the most commonly prescribed statins on the markets of Central, Eastern and South-Eastern Europe. Krka’s rosuvastatin has been holding the leading position among generic rosuvastatins on these markets since the end of 2012. (19) The wide range of rosuvastatin strengths, 5, 10, 20 and 40 mg enables adjusting the treatment to every patient’s needs in both secondary and primary prevention of CVD. With new list of drugs additional doses of 15 mg and 30 mg will be available for even better tailoring of dyslipidemia treatment.

Do not follow where the path may lead. Go instead where there is no path and leave a trail. (R. W. Emerson)