Optimizing lipid-lowering therapy in the prevention of coronary heart disease

Optimized lipid-lowering therapy is laid out in guidelines from national and international bodies. Statins are first-line treatment and instituted early in secondary prevention. The challenge in primary prevention is identification of the person at risk. This can be achieved by using scoring systems that assess classical risk factors, and then by adding information from predictive panels of biomarkers related to atherogenic pathways and by noninvasive imaging of vascular beds. At present, outcome trials validate the widespread use of statins in the population but studies of other agents have not generated proof of efficacy. Levels of high-density lipoprotein are related inversely to coronary heart disease risk but, so far, it is unclear if increasing high-density lipoprotein leads to a reduction in risk. Clinical trials on the utility of high-density lipoprotein raising on a background of statin therapy are underway.