Primary prevention trials: lessons learned about treating high-risk patients with dyslipidemia without known cardiovascular disease.

Cardiovascular disease (CVD) is the leading cause of death worldwide. Many serious cardiovascular (CV) events occur in individuals with no prior manifestation of the disease, and often result in death. Awareness of the contributions of various risk factors to the occurrence of CVD is growing. Asymptomatic individuals with multiple risk factors at low or moderate levels can be at greater risk for CVD than those with a single risk factor at a high level. Dyslipidemia and hypertension are two risk factors that commonly coexist and are modifiable through lifestyle changes and/or medications. Recent trials with hydroxymethyl-glutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) have demonstrated that aggressive cholesterol-lowering therapy in patients without known atherosclerotic disease, but at high risk for CVD with relatively normal low-density lipoprotein cholesterol (LDL-C) levels (< 130 mg/dL), can significantly reduce the number of coronary events experienced by these patients. This subset of at-risk patients is better served by this approach than by treatment solely based on degree of dyslipidemia.