Lipid management: past, present, and future

The therapeutic compounds available to the clinician treating lipid disorders in the 1990s enable the effective management of many patients. The development of the HMG-CoA reductase inhibitors is a major advance, and for the first time benefit in terms of overall mortality has been demonstrated in the impressive 4S study. What is needed now is effective implementation of screening and treatment of high-risk individuals. The UK continues to lag behind in this area. LDL cholesterol is the major target for therapy, but it is likely that over the next few years other lipid and lipoprotein parameters (HDL cholesterol, remnant particles, small dense LDL etc) will become more generally accepted targets for specific therapeutic intervention. Research continues to develop novel compounds targeting new regulatory steps in lipoprotein metabolism. In addition much progress is likely in targeting the arterial wall and atherogenesis other than specifically modulating plasma lipids. In the meantime the task of the clinician is to put into practice what is now known particularly about the secondary prevention of CHD to ensure that patients benefit from recent advances in knowledge.