Converting clinical lipid trials into the practical management of high-risk patients: New NCEP thoughts on treating CHD patients

The National Cholesterol Education Program (NCEP) guidelines published in 1993 made low-density lipoprotein cholesterol (LDL-C) the primary target of intervention. This decision was based on observations in familial hypercholesterolemia and on data from primary, secondary, and angiographic trials conducted prior to 1993. NCEP set the target goal for LDL-C as 100 mg/dL or less for secondary prevention and 130 mg/dL or less for primary prevention. Large-scale, well-designed, cholesterol-lowering trials conducted since 1993 substantiate these goal levels. In particular, the Scandinavian Simvastatin Survival Study and the Cholesterol and Recurrent Events trial showed that LDL-cholesterol-lowering with HMG-CoA reductase inhibitors (statins) reduced coronary events, coronary deaths, and total mortality in patients who had established coronary heart disease (CHD) with both elevated and normal cholesterol levels. These data, together with the NCEP guidelines, underscore the need for aggressive lipid-lowering therapy in patients at risk for CHD.