Lessons from cholesterol-lowering trials

More than 13 million individuals have coronary artery disease (CAD), and in approximately 2 million patients with congestive heart failure, CAD is the underlying cause. The cost of treating cardiovascular disease has spiraled, yet only a small percentage of the total cost is spent on preventive medical therapies and lifestyle changes that can reduce the morbidity, mortality, and disability caused by heart disease. Recent trials of cholesterol-lowering therapies have clearly shown that this treatment approach, particularly the use of the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, can significantly reduce mortality from cardiovascular events and the need for expensive hospitalization and revascularization procedures. The challenge for clinicians is to apply the important lessons learned from these clinical trials to patient care. Recent data indicate that less than half of patients with CAD receive cholesterol-lowering therapy, and few meet the low-density lipoprotein (LDL) cholesterol goal. Clinicians treating CAD need to emphasize primary and secondary prevention and recognize the key role of cholesterol-lowering therapy.