[Prevention of coronary heart disease by therapy of hyperlipidemia. Between cholesterol hysteria and therapeutic realism].

OBJECTIVES

The present paper is intended to provide an overview of the arguments for and against drug treatment of hyperlipidemia.

MAJOR TOPICS

An argument in support of lipid-lowering prophylactic and therapeutic programs is the close relationship between lipid levels and coronary heart disease, which has been documented both epidemiologically and by interventional studies. Arguments against comprehensive treatment of hyperlipidemia have to do with the fact that although large interventional studies have shown a reduction in mortality from coronary heart disease, there has been no reduction in overall mortality. Of decisive importance for the decision to apply lipid-lowering treatment is the overall risk profile of the patient concerned. This includes not only pathological lipid levels, but also numerous other factors that must be taken into account when considering the indication.

CONCLUSIONS

Whether to initiate lipid-lowering treatment or not should be determined on the basis of the individual patient's risk profile, with additional consideration being given to age and sex.