Pathophysiology of coronary heart disease: a brief review.

Coronary heart disease (CHD) remains a persistent public health burden in the United States, and it is the cause of one of every five deaths each year. The link between lipids and CHD has been firmly established, first by epidemiologic studies and, more recently, by long-term outcomes trials that demonstrated that lowering low-density lipoprotein cholesterol (LDL-C) levels significantly reduced the risk of major coronary events. Based on this evidence, the National Cholesterol Education Program recommends lowering the LDL-C level to reduce CHD risk, particularly for patients at highest risk. Recently, evidence has emerged that suggests that C-reactive protein may be a mediator of atherosclerosis and its presence may be indicative of increased risk of CHD. Although these data are intriguing, their relevance has yet to be established in prospective outcomes trials. Until then, lipid lowering through lifestyle modification and the use of safe and effective modes of therapy should be the emphasis of CHD risk reduction strategies.