Measuring and Knowing

Excerpt

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