TREATING ELEVATED CHOLESTEROL LEVELS - THE GREAT SATAN IN PERSPECTIVE

The purpose of this review is to provide perspective on the developmen ts leading to the recognition of high cholesterol levels as a risk fac tor for coronary heart disease (CHD). Another objective is to consider the unfolding controversies regarding the relative value of cholester ol-lowering drug therapy in primary and secondary prevention. Should p hysicians use lipid-lowering drugs to treat patients with elevated cho lesterol 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 scr eening large populations for the presence of elevated cholesterol leve ls or for primary prevention in those known to have high cholesterol. On the other hand, there is mounting evidence to support vigorous inte rvention in those with known coronary disease. Further study is needed to determine whether a subset of patients with one or more well-defin ed risk factors would benefit from primary prevention.