Clinical relevance of hyperlipidemia.

This review concerns the clinical impact of treating hyperlipidemia. The U.S. Lipid Research Clinics Coronary Primary Prevention Trial, the Helsinki Heart Study, and the Oslo Primary Prevention Trial all consistently showed that intensive and long-term (5-7 years) lipid-lowering treatment is successful in reducing the incidence of fatal and nonfatal myocardial infarction. Secondary prevention trials (Coronary Drug Project and the Stockholm Ischaemic Heart Disease Secondary Prevention Study) have overall confirmed this result. Assessment of progression/regression of atherosclerosis by invasive or noninvasive methods has shown that an important mechanism underlying the reduction of coronary events with long-term lipid-lowering treatment is that involving stabilization or regression of arterial lesions. An additional advantage from lipid-lowering treatment might come from useful hemodynamic changes, occurring shortly after the start of an intensive cholesterol-lowering treatment with low-density lipoprotein apheresis.