Lipid management in patients at moderate risk for coronary heart disease: insights from the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS).

The results of AFCAPS/TexCAPS provide strong evidence for the benefits of primary prevention through lipid-regulating treatment across the spectrum of clinical coronary events that are often the first manifestations of atherosclerotic disease. These results reinforce current NCEP guidelines and demonstrate the need for the inclusion of HDL-C in clinical evaluations. The clear benefit observed in AFCAPS/TexCAPS reinforces the need to implement treatment in all individuals with average LDL-C and low HDL-C who may be at risk for CHD. According to estimates based on phase-2 NHANES III data (1991-1994), only 1.4 million (6.6%) of 21.1 million American adults eligible for cholesterol-lowering drug therapy by NCEP guidelines were receiving such therapy, including 14% of those eligible in secondary prevention and 4% of those eligible in primary prevention. Of diet- or drug-eligible adults, 65% received no therapy of any kind. Undertreatment of dyslipidemia continues to be a problem today. These statistics suggest that physicians must improve their efforts to reverse the toll of atherosclerotic disease through risk factor management.