On lowering lipids in the post‐infarction patient

In patients with coronary heart disease (CHD) elevated serum cholesterol levels, like other classical risk factors, remain predictive of further coronary events. The excess risk attributable to raised cholesterol levels is considerable, and greater than that in subjects without CHD. A recent meta-analysis of all eight qualifying trials of secondary prevention of CHD by cholesterol lowering is reviewed. There were significant reductions in recurrent non-fatal and fatal CHD, with a downward trend in total mortality. Mechanisms underlying the relationship between cholesterol lowering and secondary prevention are reviewed. The implication of this analysis of trials for clinical practice is that hypercholesterolaemia should be sought and effectively treated in patients with CHD, unless contraindications are present.