Paradise Regained: Insights into Coronary Heart Disease Prevention from Recent Clinical Trials and Basic Research

Many of the uncertainties regarding the place of lipid lowering in the prevention of coronary heart disease have recently been resolved. Some of the newer findings are reviewed, and the scope for a revised clinical approach examined. The results of trials of lipid lowering, based on clinical end-points and particularly on angiographic end-points, and their meta-analyses are discussed. The close relation between coronary-angiographic and clinical outcomes is reviewed in relation to recent advances in understanding of the underlying arterial pathology, and possible underlying mechanisms are proposed. The variables predictive of progression of coronary artery disease, including nutrient intake, are examined. The management of hyperlipidaemia requires that treatment and therapeutic goals are consonant with the patient's cardiovascular risk; for this purpose, clinical and biochemical assessment of risk may be enhanced by angiographic and non-invasive methods to detect potentially-infarctogenic atherosclerotic lesions.