Primary and secondary prevention of coronary artery disease: a follow-up on clinical controlled trials

Most probably the decennia of the 1990s will be called the 'statin decennia ' in the history of coronary heart disease prevention. Statins are effectiv e, both in primary and secondary prevention of coronary heart disease, in m iddle-aged and older(<76 years) men and women, in both diabetics and non-di abetics with coronary heart disease. Statins used in secondary prevention o f coronary heart disease significantly reduce the risk of stroke. They also reduce daily attacks of myocardial ischemia. Pathogenetic pathways leading to 'biological plausibilities' of the statins favourable effects are multi ple, which explains their rapid (less than I year) influence on coronary ev ents. Until the results from new event trials become available, fibrates ha ve very few indications as first line drug therapy in dyslipidemia. They sh ould be considered in combined therapy with statins. The scientific evidenc e with statins is overwhelming and the question is no longer 'who should we treat?' but 'who can society afford to treat?'. Health economics are indee d pivotal in the use of statins and public health authorities have to find answers according to their resources or innovative strategies, including ne w aspects in dietary advice (the 'Mediterranean diet'?). Curr Opin Lipidol 9:557-564. (C) 1998 Lippincott Williams & Wilkins.