RATIONAL OF LIPID THERAPY - PREVENTION OR TREATMENT OF CORONARY HEART-DISEASE

Coronary artery disease has still a grave prognosis. More than half of the patients die within 24 hours, mostly before reaching a hospital. A minority survives the first year. Only more intense prevention will change this. Primary prevention in a narrow sense refers to the preven tion of the development of early lesions in the youth and as such is a responsibility of the education towards a healthy lifestyle. In our p opulation a majority of middle-aged is likely to have developed arteri osclerosis, so that we deal only with clinically defined primary preve ntion even though they are asymptomatic. The outstanding effects of li pid therapy in patients at risk for coronary heart disease will primar ily result from evoiding the development of instable plaques. Reductio n of LDL-cholesterol and increase of HDL-cholesterol is most effective in patients with proven coronary artery disease. Evidently the majori ty of coronary events can be prevented by idealizing the lipid paramet ers. In contrast, the chronic coronary syndrome is the domain of the i nterventional cardiology. Lipid therapy will lead only gradually to a reduction of significant coronary stenoses. However, there is the stil l insufficiently investigated potential of improving the endothelial d ysfunction by correcting the lipid metabolism to reduce angina.