Lowering cholesterol, 1988. Rationale, mechanisms, and means.

This past year, 1987, has seen publication of some important studies of the ability of cholesterol-lowering therapies to pre- vent complications of coronary heart disease (CHD)1 and to modify atherosclerotic lesions. It has also seen the release of the first ofa new class ofpotent cholesterol-lowering drugs that inhibit beta-hydroxy-beta-methylglutaryl CoA reductase. Phy- sicians are evincing new interest in treating patients with hy- percholesterolemia and there is rapidly increasing public ac- ceptance of the importance of measuring plasma cholesterol levels and acting upon the results. Clinical investigators who have been studying and treating patients with hyperlipidemia may have felt neglected in the past, but now they are showered with the attention of colleagues and patients. This attention is merited by the new information on the effectiveness of choles- terol-lowering therapies and increasing evidence that such treatment can influence health status. The recent issuance of guidelines for cholesterol lowering by the National Cholesterol Education Program provides help for practitioners and repre- sents a consensus among the majority of clinical lipidologists, but many issues regarding -indications for specific interven- tions need to be clarified. Moreover, new insights into the relationship between the plasma lipoproteins and atherogene- sis could modify currently recommended approaches.