The importance of aggressive lipid management in patients at risk: evidence from recent clinical trials.

Clinical trials that evaluate more aggressive cholesterol reduction in a broader range of patients at high risk for coronary heart disease (CHD) are needed to fill gaps in our understanding of the impact of lipid-lowering therapy on risks for clinical events and mortality. This paper briefly reviews results from recent landmark studies that have evaluated the benefits of aggressive lipid-lowering therapy in patients with, or at risk for, CHD. The Reversing Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) study demonstrated that aggressive treatment with atorvastatin was significantly more effective than less aggressive therapy with pravastatin in slowing the progression of atherosclerosis in patients with symptomatic CHD. Results from two large-scale clinical end-point trials, the Heart Protection Study (HPS) and the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA), have shown that aggressive lipid-lowering treatment in patients with relatively low baseline levels of low-density lipoprotein cholesterol (LDL-C) significantly reduces CHD risk. Taken together, the results of these landmark trials not only support aggressive lipid lowering in patients at risk for CHD, but also suggest that greater LDL-C reductions may improve outcomes across a wide range of patients.