Risk factor modification: rationale for management of dyslipidemia.

Overview

A number of recent clinical trials have clearly demonstrated the efficacy of cholesterol lowering as a risk-reduction strategy for the primary and secondary prevention of coronary artery disease (CAD). The Scandinavian Simvastatin Survival Study (4S), the West of Scotland Coronary Prevention Study (WOSCOPS), and the Cholesterol and Recurrent Events (CARE) trial, as well as numerous other investigations, have established that decreasing elevated levels of low-density lipoprotein (LDL) cholesterol will result in a reduction in CAD risk. This has been reported since the 1980s, when the first of the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors ("statins") became available. These drugs were an important advance because they showed better patient compliance due to fewer side effects when compared with other lipid-lowering agents. Nonetheless, many physicians, for various reasons, have not done an adequate job of ensuring that the millions of patients who could benefit from lipid-lowering therapy actually receive the treatment they require.