Cholesterol: precursor to many lipid disorders.

Despite advances in treatment and prevention, coronary heart disease (CHD) remains the leading cause of death in the United States. A major risk factor for CHD is elevated low-density lipoprotein cholesterol (LDL-C). Randomized clinical trials have proven that lowering LDL-C to near target levels significantly reduces CHD risk. More aggressive LDL-C reductions would have an even greater impact on reducing CHD risk if these goal levels were applied to all patients at risk, as identified by a CHD risk prediction scoring system. In 1993 the second Adult Treatment Panel (ATP II) of the National Cholesterol Education Program issued guidelines that defined CHD risk on the basis of whether a patient qualified for primary or secondary prevention. The ATP III guidelines, issued May 2001, introduce the concept of CHD-equivalent risk in patients without known CHD, thereby expanding considerably the number of people eligible for lipid-lowering therapy. Unfortunately, many patients who are eligible for therapy are not receiving it, and among those on lipid-lowering therapy, less than half have achieved their treatment goals. As mentioned, findings from several large-scale primary- and secondary-prevention trials with statins and other lipid-lowering agents have shown that lowering LDL-C reduces the risk for fatal and nonfatal coronary events and results in fewer hospitalizations and revascularization procedures. In fact, a review of the 5 major statin trials reveals that the higher the patient's baseline CHD risk, the more striking the benefits of therapy are. Clearly, the need to lower LDL-C levels is crucial. Meeting this need involves targeting patients who are at risk, implementing appropriate treatment, and ensuring compliance with therapy.