In the wake of the Scandinavian Simvastatin Survival Study trial.

Purpose of review: In 1994, the 4S trial was revolutionary by showing that cholesterol lowering with simvastatin reduced, not only atherosclerotic vascular disease (ASCVD) events, but also all-cause mortality as compared to placebo. During the following 30 years, statins have proved to be well tolerated and effective and also paved way for new innovations in the field of dyslipidaemia therapy.

Recent findings: The aim of this review is to summarize current knowledge about statins and effects of cholesterol-lowering accumulated in the wake of 4S trial: both vascular and nonvascular benefits, adverse effects, adherence, and statin intolerance. While secondary prevention of ASCVD has emphasized 'the lower the better' in LDL-cholesterol lowering, emerging topic is 'the longer the better' to reduce lifetime LDL burden and achieve full potential of ASCVD prevention. With statins as backbone therapy, new treatment innovations are in trials to better manage all atherosclerotic lipoproteins and residual risk.

Summary: After becoming generic, statins are inexpensive and well tolerated therapy with potential to substantially reduce the burden of atherosclerotic vascular disease world-wide. To achieve these goals, both accessibility and adherence are fundamental issues.