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April 9, 2001

Primary Prevention of Coronary Heart Disease: Where Do We Go From Here?

Arch Intern Med. 2001;161(7):922-924. doi:10.1001/archinte.161.7.922

ALTHOUGH THERE is little to no controversy about controlling lipids in patients with manifest atherosclerosis, the role of primary prevention has been a subject of considerable debate, with cogent arguments on all sides informed by pathology, epidemiology, ethics, and health economics. These issues have been consolidated generally under the rubric of "evidence-based medicine," in which the gold standard for any intervention has become hard clinical end-point data from well-designed, adequately powered studies. The case for lipid control to prevent coronary disease in asymptomatic patients has been made by several such trials, including the Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT) of cholestyramine,1 the Helsinki Heart Study (HHS) of gemfibrozil,2 the West of Scotland Coronary Prevention Study (WOSCOPS) of pravastatin,3 and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) of lovastatin.4

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