Statins have shown major improvement in cardiac events consistently. Residual risk still prevails even after aggressive reduction of LDL cholesterol, i.e. low HDL and high triglyceride. Medications to modify the triglyceride and HDL-C have failed to reduce athero-thrombosis.
ACCORD trail (Action to control cardiovascular risk in Diabetes) with fenofibrate, ILLUMINATE with torcetrapib and also recently Dalcetrapib showed no clinical benefit in reduction cardiovascular events. AIM-HIGH with niacin showed no clinical benefit. All these trials showed modulation of HDL-C and or triglyceride but without clinical benefit.
It appears that life style modification a major need for further reduction cardiovascular events, both before and after statins use especially in diabetics and metabolic syndrome.