Treating mild hypercholesterolemia in the absence of overt cardiovascular disease: if, when, and why?

Cohort data define a range of cholesterol concentrations (160-200 mg/dl), which is desirable in terms of public health. Cholesterol-lowering treatment leading to a serum cholesterol in this range is favorable for coronary heart disease prevention and safe in terms of noncardiovascular mortality. In individuals with moderate cholesterol elevation and without other coronary risk factors, the physician should encourage a healthy lifestyle and give prudent nutritional advice. Detection of asymptomatic cardiovascular disease by noninvasive methods might be used to identify individuals with mild hypercholesterolemia, but nevertheless at high risk for ischemic accidents. The aim of lipid-lowering treatment is to improve life expectancy through reduction of a major cause of premature death.