Lowering Serum Cholesterol

The relationship between elevated serum cholesterol levels, especially elevated low density lipoprotein (LDL) cholesterol levels, and coronary artery disease is well established.¹Lowering LDL levels by means of diet and/or drug therapy has been shown to decrease the incidence of coronary events.²⁻⁴Indeed, as predicted from the Framingham Study,⁵a 10% decrease in cholesterol levels is associated with a 20% decrease in coronary events.⁶ Given this information, how do we proceed? As pointed out by the report⁷in this issue of theArchivesof the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, a working group of the National Cholesterol Education Program, there are two basic, complementary approaches. The public health (or population) strategy aims to shift the distribution of cholesterol levels of the entire population to a lower range. There is little doubt that the lowering of cholesterol levels