[Primary prevention of coronary heart disease with drugs: wishful thinking or reality?].

The primary prevention of coronary artery disease remains a controversial issue. Beside the much disputed lipid-lowering drugs we have additional possibilities for a pharmacological intervention, such as the administration of antioxidants (e.g. vitamin E), aspirine or estrogens. In this article the epidemiological data with such treatments are presented. In selected populations the relative risk of cardiovascular events could be reduced 40 to 60% by vitamin-E supplements, low-dose aspirine and estrogen replacement in postmenopausal women. The protective effects are most marked in persons over 50 years with coexistent cardiovascular risk factors. There are, however, also potential dangers of a primary prophylaxis by drugs, such as the increased risk of cerebral and gastrointestinal hemorrhage with aspirine or the induction of endometrial carcinoma or breast cancer with estrogens. For this reason dietary and life style counselling should remain the most important measure in primary prophylaxis. In individuals with cardiovascular risk factors--which should be eliminated, if possible--additional administration of aspirine, estrogens or antioxidants may be considered after a careful evaluation of the overall risk/benefit ratio.