The future of best practice.

Evidence from epidemiological and clinical studies continues to improve our understanding of the pathogenesis of coronary heart disease (CHD). However, despite major advances in the development of diagnostic methods and effective treatment, CHD remains the leading cause of mortality in the Western world. That cholesterol lowering is of major importance in lowering the risk of developing coronary artery disease (CAD) is now an accepted principle in medicine. Most patients with CAD will require drug therapy to achieve target lipid levels. Subgroup analyses of data from the landmark statin trials show that this benefit is seen in all patient groups: male and female, older and younger patients, diabetics and non-diabetics, and patients with and without myocardial revascularization. Recent evidence suggests that the extent to which cholesterol is lowered is also important and that the attainment of reduced low-density lipoprotein cholesterol levels is associated with greater reductions in the risk of cardiovascular events. Unfortunately, data from studies to date do not provide a definitive answer to the question of whether there is a benefit in lowering cholesterol to very low levels.