[Evidence of the efficacy of hypocholesterolemic treatment in primary and secondary prevention of ischemic heart disease].

Good clinical medicine is, nowadays, not based on personal experiences, but in the results of broad prospective controlled studies considering the experience of many professionals, which in the case of new therapeutic options are named clinical trials. Several evidences of the determinant role of cholesterol in the development of atherosclerosis are reviewed. Pathologic studies illustrate the presence of cholesterol in atheroma plaques, with a good correlation between the severity of lesions and the amount of cholesterol in the plaques. Animal experiences demonstrate that hypercholesterolemia, rarely spontaneous, usually induced with dietary modifications, induces atherosclerosis in animals. Observation of patients with genetic-based hypercholesterolemia shows a high frequency of coronary atherosclerosis among them, and the broad cohort studies corroborate a good correlation between cholesterolemia and coronary heart disease. Finally, hypolipidemic intervention trials, mainly with drugs, and specially with statins, have clearly defined the benefits in coronary risk reduction.