MODIFYING SERUM-LIPIDS TO PREVENT CORONARY HEART-DISEASE - DO WE HAVEA CONSENSUS

Despite the importance of hyperlipidemia as an independent coronary ri sk factor and the positive results of recent lipid intervention trials to prevent coronary disease, there remain many unanswered questions r egarding the benefits and risks of treating hyperlipidemia. Critical r eview of epidemiologic studies and clinical trials suggest that the be nefits of cholesterol reduction may vary depending on the patient's ag e, sex, and the presence of other coronary risk factors. Furthermore, one must recognize that there is a small but consistent increase in no ncoronary deaths among patients receiving cholesterol-lowering medicat ions that remains unexplained but requires further evaluation. These d ata underscore the importance of weighing both the risks and benefits of modifying serum lipids. Accordingly, careful evaluation of the unde rlying risk of developing coronary disease and the potential long-term benefits of intervention are necessary to identify appropriate high-r isk patients for treatment among whom the predicted benefits will outw eigh the risks.