Lower patients' cholesterol now

BMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6990.1280 (Published 20 May 1995) Cite this as: BMJ 1995;310:1280
  1. Michael Oliver,
  2. Philip Poole-Wilson,
  3. James Shepherd,
  4. Matti J Tikkanen
  1. Professor emeritus Professor of cardiac medicine National Heart and Lung Institute, London SW3 6LY
  2. Professor of pathological chemistry Royal Infirmary, Glasgow G4 0SF
  3. Professor of medicine Department of Medicine, Division of Cardiology, Helsinki University, Central Hospital, SF-00290 Helsinki 29, Finland

    Trial evidence shows clear benefits from secondary prevention

    The first principle of the lipid hypothesis is that raised plasma cholesterol concentrations are associated with a high incidence of atherosclerosis and an increased risk of coronary heart disease. That assertion no longer stirs argument in medical circles. But the second principle—that both this risk and total mortality can be reduced by lowering plasma cholesterol concentrations—remains controversial. Polarisation of views has led over the past 20 years to the emergence of enthusiasts for whom cholesterol lowering and the prevention of coronary heart disease are almost synonymous and sceptics who attribute to lipid reduction more harm than good. This lack of consensus has been widely publicised by the media, and many people believe that the case for treating raised cholesterol concentrations is flawed and can be disregarded. The publication in 1994 of the results of several new trials has shown that this attitude is no longer tenable for one clearly defined category of patients—those who have already developed coronary heart disease.

    Clinical decisions are rarely black or white. More often than not they are made with incomplete knowledge. This is certainly true in the prevention of cardiovascular disease. No one would challenge a policy aimed at reducing cigarette smoking, even in the absence of formal evidence from trials of a positive effect on the incidence of coronary …

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