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The Trouble With Cholesterol and Decision Making

John T. Gwynne, MD

JAMA. 1991;266(12):1696-1698.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

The evidence that lowering serum low-density lipoprotein (LDL) cholesterol levels prevents both primary and recurrent myocardial infarction now seems overwhelming. Two major primary prospective intervention trials, the Lipid Research Primary Prevention Trial^1,2 and the Helsinki Heart Study,^3,4 have shown that lowering total and LDL cholesterol levels will decrease the incidence of fatal and nonfatal myocardial infarctions in high-risk middle age men. The outcome of these trials is quantitatively consistent with less-definitive primary prevention trials employing diet alone and is consistent with the degree of benefit predicted by observational epidemiologic studies relating total cholesterol to coronary artery disease risk.^2,5 Treatment with nicotinic acid as part of the Coronary Drug Project, a secondary prevention trial in middle-aged men, not only decreased the incidence of nonfatal reinfarction⁶ but also appeared to have decreased mortality at the 15-year follow-up.⁷ The results of recent pharmacologic . . . [Full Text PDF of this Article]

Author Affiliations
From the Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina, Chapel Hill.

Footnotes
Reprint requests to the Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina, CB 7170, MacNider Building, Chapel Hill, NC 27599-7170 (Dr Gwynne).

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