Lowering cholesterol for prevention of coronary heart disease--problems and perspectives.

The evidence for aggressive treatment of severe hypercholesterolemia in men in order to reduce the development on a primary basis of the incidence of coronary heart disease is strong; the main benefit is reduction of morbidity. Extrapolation to women or to the management of mild hypercholesterolemia in either gender is not supported by facts. The value of reducing hypercholesterolemia in the young and in the elderly has not been tested. None of the primary or secondary prevention trials have reduced all-cause mortality. There is an inverse relation between cholesterol levels and noncardiovascular disease. The possibility that reducing mild to moderate elevation of cholesterol might be harmful to some people remains unanswered.