Modifying serum lipids to prevent coronary heart disease: do we have a consensus?

Despite the importance of hyperlipidemia as an independent coronary risk factor and the positive results of recent lipid intervention trials to prevent coronary disease, there remain many unanswered questions regarding the benefits and risks of treating hyperlipidemia. Critical review of epidemiologic studies and clinical trials suggest that the benefits of cholesterol reduction may vary depending on the patient's age, sex, and the presence of other coronary risk factors. Furthermore, one must recognize that there is a small but consistent increase in noncoronary deaths among patients receiving cholesterol-lowering medications that remains unexplained but requires further evaluation. These data underscore the importance of weighing both the risks and benefits of modifying serum lipids. Accordingly, careful evaluation of the underlying risk of developing coronary disease and the potential long-term benefits of intervention are necessary to identify appropriate high-risk patients for treatment among whom the predicted benefits will outweigh the risks.