[Rationale for lipid therapy. Prevention or treatment of coronary heart disease?]

Coronary artery disease has still a grave prognosis. More than half the patients die within 24 hours, mostly before reaching a hospital. A minority survives the first year. Only more intense prevention will change this. Primary prevention in a narrow sense refers to the prevention of the development of early lesions in the youth and as such is a responsibility of the education towards a healthy lifestyle. In our population a majority of middle-aged is likely to have developed arteriosclerosis, so that we deal only with clinically defined primary prevention even though they are asymptomatic. The outstanding effects of lipid therapy in patients at risk for coronary heart disease will primarily result from avoiding the development of instable plaques. Reduction of LDL-cholesterol and increase of HDL-cholesterol is most effective in patients with proven coronary artery disease. Evidently the majority of coronary events can be prevented by idealizing the lipid parameters. In contrast, the chronic coronary syndrome is the domain of the interventional cardiology. Lipid therapy will lead only gradually to a reduction of significant coronary stenoses. However, there is the still insufficiently investigated potential of improving the endothelial dysfunction by correcting the lipid metabolism to reduce angina.