Lipid-lowering trials: results and limitations

Because the accumulation of lipids is central to the development and progression of coronary atherosclerosis, interventions (drugs, diet, or surgery) designed to reduce serum cholesterol levels have been tested in a large number of clinical trials, which began in the early 1960s. Data from such trials are now available on more than 45,000 participants, most of whom were men. Nevertheless, debate continues regarding the benefits of lipid-lowering therapy, to a large extent because of methodologic limitations that characterized most trials. Despite their limitations, however, the combined data from these trials demonstrate a reduction in incidence of coronary heart disease after a lag time of 2 or more years. This article reviews combined results of lipid-lowering trials based on published and nonpublished meta-analyses.