Cholesterol-lowering therapy: is there really a controversy?

Geurian concludes that recommendations for the management of hypercholesterolemia are difficult to make because a previously black and white issue is becoming "increasingly gray." Actually, it appears that the opposite is occurring. Our knowledge of atherogenesis, as well as the mechanisms by which thromboembolic events occur, continues to expand. We are gaining new insights into the mechanisms by which cholesterol-lowering therapy can prevent the development of coronary events. Newer cholesterol-lowering agents are more potent than those previously available and make substantial reductions more readily achievable. Finally, we are gaining a better understanding of the relative benefits of cholesterol-lowering therapy in various patient populations, although more work is needed, particularly in women and older patients. Cholesterol-lowering therapy has had an important positive impact on CHD, particularly in preventing recurrent events and reducing mortality when used as secondary prevention. Clearly, there are substantial numbers of patients who will benefit greatly from cholesterol-lowering drugs, and clinicans should not be dissuaded from providing this valuable form of drug therapy.