Treating elevated cholesterol levels: the great Satan in perspective.
The purpose of this review is to provide perspective on the developments leading to the recognition of high cholesterol levels as a risk factor for coronary heart disease (CHD). Another objective is to consider the unfolding controversies regarding the relative value of cholesterol-lowering drug therapy in primary and secondary prevention. Should physicians use lipid-lowering drugs to treat patients with elevated cholesterol levels but no clinical evidence of coronary disease, or limit intervention to patients with a previous history of angina, coronary angioplasty, coronary artery bypass surgery, or myocardial infarction? This review finds inadequate data to support a recommendation for screening large populations for the presence of elevated cholesterol levels or for primary prevention in those known to have high cholesterol. On the other hand, there is mounting evidence to support vigorous intervention in those with known coronary disease. Further study is needed to determine whether a subset of patients with one or more well-defined risk factors would benefit from primary prevention.
Gibaldi
M
M
School of Pharmacy, University of Washington, Seattle 98195, USA.
Kradjan
W
W
D000818:Animals; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002792:Cholestyramine Resin / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000517:prevention & control*; D015248:Gemfibrozil / Q000627:therapeutic use; D006291:Health Policy; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors; D014481:United States
D000924:Anticholesteremic Agents; D002792:Cholestyramine Resin; D015248:Gemfibrozil