Impact of dyslipidaemia - Lessons from clinical trials

Coronary heart disease (CHD) is a major cause of morbidity and mortality in Western countries, and is associated with significant healthcare costs. Ep idemiological studies have shown that elevated cholesterol levels, particul arly elevated low density lipoprotein (LDL) cholesterol, are a major establ ished risk factor for the development of CHD. There is a large amount of cl inical data available to indicate that lowering total or LDL-cholesterol le vels reduces the risk of cardiovascular events and mortality. The most rece nt cholesterol treatment guidelines from the US and Europe recommend intens ive treatment (usually pharmacological) for patients at highest risk for CH D. Results from a number of landmark primary and secondary prevention studi es are in support of these guidelines and also suggest that the lower the l evel of LDL-cholesterol achieved with treatment, the better clinical benefi t attained. Thus, these findings indicate that even more aggressive lipid l owering than that recommended by available treatment guidelines may be warr anted. Finding and treating all individuals at risk for CHD would be expected to i ncrease the overall treatment costs of hypercholesterolaemia because many p atients may not otherwise be treated; however, targeting high risk patients , rather than treating all patients or treating inappropriately, would be e xpected to reduce other healthcare costs and the indirect costs of lost pro ductivity due to cardiovascular morbidity and mortality. Studies with the H MG-CoA reductase inhibitors, which show that these drugs substantially lowe r LDL-cholesterol, are the most convincing since they have consistently sho wn reductions in cardiovascular morbidity and mortality. As a result, stati ns are now well-established agents for the treatment of dyslipidaemia.