LIPID-LOWERING AND CORONARY RISK

Clinical trials have provided increasing evidence of the value of lipi d lowering in preventing clinical coronary events. With the advent of more potent lipid-regulating agents, a greater degree of cholesterol l owering - particularly of cholesterol carried in low density lipoprote ins - is now possible. Trials monitored by angiography or ultrasound h ave demonstrated slowed progression and even regression of atheroscler otic lesions in subjects in whom lipid lowering was accomplished by di et and other lifestyle modifications, drugs, and/or partial ileal bypa ss surgery, but the changes measured in the vessel lumen or wall are o ften modest compared with the reduction in clinical events, suggesting that clinical benefit may be derived from mechanisms other than the a bsolute decrease in lesion size. Possible mechanisms include lesion st abilization, improved endothelial function, increased vascular reactiv ity, and decreased inflammatory response. The identification of risk f actors besides elevated blood cholesterol level, such as lipoprotein o xidation, blood triglyceride level and insulin resistance, may provide additional targets for intervention.