Practicing effective preventive medicine. Pharmacologic interventions in coronary heart disease.

Epidemiologic and clinical evidence clearly documents the relationship between elevated levels of low-density lipoprotein cholesterol (LDL-C) and risk of coronary heart disease (CHD). In order to reduce CHD risk, the National Cholesterol Education Program (NCEP) has identified LDL-C goals that can be achieved through appropriate use of lipid-lowering medications, diet, and exercise. Unfortunately, most patients with dyslipidemia are not achieving the NCEP-defined LDL-C goals in clinical practice. Accordingly, greater focus on preventive medicine is needed, whether the patient is seen in the hospital or in an outpatient setting. Preventing major cardiovascular events from occurring and intervening in patients with existing CHD are complementary strategies. Although the term intervention implies catheter-based approaches in cardiology, use of risk-lowering medications is also interventional in patients who have or are at risk for cardiovascular disease. The keys to improved delivery of preventive medicine are recognition that effective medications are available, provision of patient education, and reinforcement of the importance of these medications.