ABSTRACT
With the publication of landmark statin-based cholesterol-lowering trials described earlier in this book, a new certainty has entered the language of those who formulate guidelines for best practice in coronary prevention. Trials from the pre-statin era, the Lipid Research Clinics Primary Prevention Trial and the Helsinki Heart Study (HHS),1,2 provided evidence of the benefits of lipid correction for the enthusiasts but left the vast majority of clinicians unconvinced as to the net gain to be obtained from widespread use of cholesterol-lowering agents. These studies demonstrated reductions in coronary morbidity with bile acid sequestrant (cholestyramine) or fibrate (gemfibrozil) treatments but had no clear effect on coronary or total mortality. Indeed there were calls for a moratorium on the use of lipid-lowering drugs outside those at very high risk of coronary heart disease (CHD);3 increased risk of cancer, suicide or violent death was touted as the downside of cholesterol lowering, and opinion leaders became polarized and the general physician confused.
