[Cholesterol-lowering therapy; a recommendation from the Health Council]

The recent report on lipid lowering therapy from the Netherlands Health Council is largely in agreement with the 1998 guidelines made at the Dutch Institute for Health Care Improvement CBO on the same topic. In addition to advice for a healthy life style and no smoking, lipid lowering therapy (particularly statins) is recommended in: patients with familial hyperlipidaemia; patients with atherosclerotic disease and a total cholesterol > 5.0 mmol/l; patients with diabetes and multiple risk factors including a total cholesterol > 5.0 mmol/l; other persons with markedly increased risk for development of coronary artery disease. The report does not dwell upon implementation and effects of the recommendations or on the question what preventive efforts are desirable for persons without manifest cardiovascular disease. In practice, prescribing the recommended medication is more successful than attempts to change the life style. The effects of multifactorial life style intervention may be considerable, however. The high social costs of cholesterol-lowering treatment should be regarded as an investment in health.