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
The Coronary Drug ProjectInitial Findings Leading to Modifications of Its Research Protocol. JAMA. 1970;214(7):1303–1313. doi:10.1001/jama.1970.03180070069012