Physicians face a difficult dilemma concerning pharmacologic therapy for hyperlipidemia in patients with a history of clinical coronary heart disease (CHD). They know that susceptibility to first episodes of premature CHD is directly related to serum levels of cholesterol, and low-density and very-low-density lipoproteins.1 They are also aware that elevated serum lipids-lipoproteins frequently can be reduced long-term by available drugs. However, they lack the answers to key questions about these pharmaceutical agents: Do they prevent recurrent episodes of CHD and prolong life? What is their mechanism of action? Are they reasonably safe, in long-term usage?
The paucity of scientific data on these critical questions is especially troublesome in view of other problems: Treatment of coronary disease by control hyperlipidemia makes sense only as years-long therapy— and questions about drug toxicity are especially gnawing under this circumstance. Furthermore, almost all the data proving the association between hyperlipidemia and risk of