Assessing the benefits of lipid-lowering therapy.

In recent years, a substantial body of evidence has emerged to support the use of lipid-lowering therapy in the prevention of coronary artery disease, and many physician groups have endorsed the management of dyslipidemia in at-risk patients. An important consideration in such endorsements has been the issue of the safety of lipid intervention; many early primary- and secondary-prevention studies reported either no reduction in all-cause mortality rates or an increase in non-coronary artery disease mortality rates in treated patients. These observations raised serious concerns about the safety of such therapy. However, 2 landmark studies, the Scandinavian Simvastatin Survival Study (4S) and the West of Scotland Coronary Prevention Study (WOSCOPS), have contributed greatly to alleviating these concerns. In this article, a review of the epidemiologic evidence supporting the use of lipid modification will be presented, including important trials and meta-analyses, and the cost-effectiveness of lipid-modifying treatment will be discussed.