Serum Lipid Lowering in Secondary Prevention: A Review

Few people would contest the fact that atherosclerosis in general and coronary heart disease (CHD) in particular is less frequent in populations with low mean serum lipid levels. The wide gap between this basic fact and the high expectations implied in the title become even more conspicuous when one considers the two jumps in logic separating the two. The first jump implies that reduction of elevated lipids restores the protection against CHD to the same level as would be linked with a low-lipid level a limine. The second jump assumes that lipid correction acts as forcefully after the manifestation of CHD as during its protracted development. Both assumptions are poorly proven — if at all — and this fact should be kept in mind before reviewing the secondary preventive trials performed up to now.