Future of lipid-lowering trials: what else do we need to know?

Convincing clinical trial evidence shows that lipid-lowering therapy can be effective in primary and secondary prevention of coronary artery disease events. At least 2 studies indicate that this benefit extends to persons with only mild or moderate hypercholesterolemia. The benefits of lipid-lowering therapy in certain subpopulations, however, remains to be elucidated. The effects in women, African Americans, the elderly, and patients with concomitant coronary artery disease risk factors such as diabetes and hypertension are only recently being studied in large, well-designed trials. Other trials, described herein, are studying the benefits of therapy in persons with coronary artery disease and low levels of high-density lipoprotein (HDL) cholesterol (but normal or only mildly elevated total or low-density lipoprotein [LDL] cholesterol). Future trials are needed to assess prospectively the value of aggressive lipid-lowering therapy on coronary artery disease events in diabetic patients with and without coronary artery disease. New drug therapies and innovative uses for existing therapies are being developed that may have an important impact on the prevention of coronary artery disease.