Lipids and vascular disease: what we do and do not know

The demonstration that lowering the level of low-density Lipoproteins (LDL) in plasma substantially reduces the incidence of death and symptomatic cor onary disease may be the most important advance ever in cardiovascular ther apeutics. Indeed it has been perceived as so dramatic that it could give ri se to the view that the only problem now is application. That would be unfo rtunate because critical questions remain unanswered. Amongst these are whe ther all patients with coronary disease will benefit from LDL lowering and what should be the target of such therapy. Moreover, it remains uncertain w hether other approaches such as lowering triglycerides should also be stron gly supported. More fundamentally, inadequacies in what has become the trad itional approach to characterize risk are becoming increasingly evident. Th is paper will outline issues that remain unresolved and suggest clinical ap proaches to deal with them. (C) 1999 Elsevier Science B.V. All rights reser ved.