Lipid-lowering drugs and prevention of coronary heart disease.

Hypercholesterolemia, particulary high levels of LDL-cholesterol, is a well established risk factor for coronary heart disease, Lipid-lowering therapies are associated with a reduction in cardiovascular morbidity and mortality in secondary as well as primary prevention. These trials are consistent with epidemiological studies and emphasize the importance of the benefit in terms of the number of cardiovascular events avoided per 1000 patients treated. However, extrapolation of the data to general practice must be cautions, as most of the trials were conducted in populations displaying a high absolute risk level, including few women, and excluding persons older than 75 years. However, subgroup analysis showed that the beneficial effect is independent of age and pretreatment lipid levels in the range studied. The precise lipid pattern should be considered before any treatment is started. Diet is the first step approach and should be continued even after introduction of lipid-lowering drug therapy. Statins are treatments of choice in case of hypercholesterolemia type IIa. The target level of LDL-cholesterol is less than 1.30 g/l in patients with known coronary heart disease. Fibrates may be useful in patients with hypertriglyceridemia, and/or low HDL-cholesterol level or in the case of intolerance to statins.