Prevention of coronary artery disease - Evidence-based medicine in lipidology

A considerable number of large scale clinical trials provide clear evidence that cholesterol lowering is one of the most important risk-reduction stra tegies for secondary and primary prevention of coronary artery disease. Unl ike the older studies with fibrates, the most recent trials of cholesterol- lowering therapies with the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors have clearly shown that their use can reduce coronary artery disease and total mortality as well as the need for expensive hospi talization and revascularization procedures. Studies such as the Scandinavi an Simvastatin Survival Study (4S), the West of Scotland Coronary Preventio n Study (WOS), the Cholesterol and Recurrent Events (CARE) trial and most r ecently the Long-Term Intervention with Pravastatin in Ischaemic Disease (L IPID) as well as numerous other investigations, have established that decre asing elevated levels of low-density lipoprotein (LDL) cholesterol will res ult in a reduction in risk of coronary artery disease. In additon, HMG-CoA reductase inhibition reduces the risk for cerebral ischemia. Recent data in dicate that less than half of patients with coronary artery disease receive cholesterol-lowering therapy, and few meet the LDL-cholesterol goal. There fore clinicians treating coronary artery disease need to emphasize secondar y prevention and recognize the key role of cholesterol-lowering therapy. Th e challenge for clinicians is to apply the important lessons learned from t hese clinical trials to an "evidence-based'' patient care.