Chemoprevention of coronary atherosclerosis: the role of lipid interventions. A position paper of the American Council on Science and Health

Atherosclerosis is not an inexorable part of aging. Addressing unhealthy lifestyle behaviors will go a long way toward reducing the current burden of atherosclerosis without widespread drug therapy. The question is whether this is possible, given the demand of our modern culture. It is not yet clearly established precisely where pharmaceutical lipid lowering or chemoprevention fits in the broader spectrum of prevention and treatment of atherosclerosis and its complications. Anatomic interventions, such as angioplasty or bypass surgery, targeted to obstructing but stable lesions, are likely to be only of limited effectiveness. On the other hand, cholesterol interventions, not only as a long-term means of dealing with atherosclerotic sequelae but as a short-term means of reducing plaque activity and events, are demonstrably effective. Aggressive cholesterol lowering will, moreover, substantially reduce the requirement for angioplasty and bypass procedures. Although more difficult to prove, earlier intervention can almost surely lower the risk of later, potentially lethal, coronary events.