The impact of lipid lowering in coronary artery disease.

A growing number of clinical trials using various methods of lowering cholesterol levels have demonstrated that cholesterol lowering decreases the risk of coronary disease in both primary and secondary prevention. Recent clinical and angiographic trials have shown beneficial effects of cholesterol lowering in patients with average cholesterol levels and with other lipid abnormalities. Studies using aggressive low-density lipoprotein (LDL) lowering have demonstrated improvements in angiographic endpoints and the functional capacity of patients. Data from other studies suggest improvement in endothelial function and in ischemia with LDL lowering. The challenge for the future is to extend the benefits of therapy to more patients and to expand our knowledge about other lipid and nonlipid risk factors to decrease the risk of coronary heart disease.