Treating elevated lipids. Does it make a difference?

Abstract

BACKGROUND: There is now abundant evidence from clinical trials that treatment with lipid modifying therapy will decrease the risk of coronary heart disease (CHD). The decision to treat a patient, whether with advice on lifestyle modification or with drug therapy, needs to be based on consideration of costs versus benefits. OBJECTIVE: To assess the evidence from primary and secondary prevention studies for cardiovascular benefit of cholesterol lowering medication. DISCUSSION: Treating hypercholesterolaemia reduces the relative risk of major CHD events by about 30%. The greatest benefit of lipid lowering treatment is in the high risk group. This group shows the greatest reduction in absolute risk and therefore a 'smaller number to treat' to prevent one major CHD event. In the moderate risk group three times as many individuals require treatment to prevent one major CHD event. However, this corresponds to the benefit in primary prevention of stroke by treating mild-moderate hypertension in middle aged men.